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<br />FiECEiVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />The Fort Lyon Canal Company <br />M-2001-097 <br />Fort Lyon -State Pit No. 1 <br />October 8, 2003 <br />SEP 1 2 2003 <br />Qivision ~f Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Bent <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamauon accompusnea ro aare ana aurtng me preceatng year, new atsmroances mar are annctpa[ea to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written anneal red nrt and anneal rennrt m ~n to this form. Please note that an <br />adegz~ately Labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Manuel Torrez <br />Permittee Name: The Fort Lyon Canal Company <br />Address: 750 S. Bent Ave. <br />~0 lJt.W M..aM.la't~s ~tr<gY...r ~,it <br />tiw~V Ali s.01~~gcwr~ <br />~,41~ <br />Las Animas, CO 81054 <br />Phone Number: _ (719) 456-0720 <br />Fax Number: (719) 456-1609 <br />Gc oEam MTt d. Zlwc $ ntn.ES bd~ <br />bil. w.~at~.. Wv.ta ut ~o yo .a .o <br />~Q vQ ~+^ua-E. yC.tt~Ui~ w4 tau, DSO <br />. _ CECWI'n SOh.t gWVnt t~. <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />\v,.,,,~~ \ o ~.,,,y <br />Signature of Corporate Officer, Owner, or Designee <br />,9_io-o3 <br />Date <br />M:~PERM ITU7ASTERD000MENTSQd-AF-01 <br />