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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNTiAT, FF,F, and RF,PnRT RFOTiF.ST <br />DG Huskin Construction Company <br />M-2000-118 <br />Pino Pit <br />November 15, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Huerfano <br />RECEIVED <br />NOV 12 2003 <br />p9rislon ~i Minerals and Geology <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_submiLthe annual _fee, _a_report_ and .map_shawing~he_extent~Lcurreat_distur¢ances_to_affected_land, _ <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 ynnr revised written annnal rennrt and annual rennrt m ~n to this form. Please note that an <br />adequately 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 ariy necessary <br />changes: '~, <br />~. <br />Permittee Contact: Richard L. Pounds <br />Permittee Name: DG Huskin Construction Company <br />Address: P.O. Box 61 <br />Westmore, CO 81253 <br />Phone Number: (719) 784-04I5 <br />Fax_Number:--_~(,Zl-9)-546-2143. _ .-- - _- -- _ ----- - -- "~`'a- - ~ - . <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 />1 ' <br />Signature of Corp rate Officer, Owner, or Designee <br />1 ~-~ <br />Date <br />M:~PERMIT~MASTERD000M ENTSVN-AF-01 <br />