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~, ~L <br />~- ~ <br /> ANNi1Ai. FF.F. and RF.P(lRT R F.niTEST <br />~~dd <br />PERMITTEE NAME: Don Kehn Construction, Inc. <br />PERMff NO.: M-1989-056 SAN 181004 <br />OPERATION NAME: Timnath Pit n'J15ivn of PAfne~als a <br /> nd Geolo9Y <br />ANNIVERSARY DATE: February 24, 2004 <br />ANNLIAL FEE DUE: $688.00 (Due on or before you r anniversary date) <br />COUNTY: Latimer <br />~'° <br />_ _ According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator <br />shall submit the annual-fee; areport-and-map showing-the extent-of-current-disturbances to,.affected 1_and, _ _ <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated 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 annnal report and anm~al rennrt m ~n fn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Kehn <br />Permittee Name: Don Kehn Construction, Inc. <br />Address: 6550 S. County Rd. 5 <br />Fort Collins, CO 80528 <br />Phone Number: (970) 226-4111 <br />Fax Number: (970) 226-4115 <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 />Signature of Corporate Officer, Owner, or Designee <br />/- ~7-o5C <br />Date <br />-~C. <br />MiPERMInMASTERDOCUMENTSNI-AF-01 <br />