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<br />RECEtVE~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Orlando & Rose Marie Martinez <br />M-1985-008 <br />Leone-Gardner Gravel <br />March 22, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Huerfano <br />MAR 2 1 2: ~., <br />Division ~f 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 submit the annual fee, a report and map showing the extent of current disturbances 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 atta~ynnr revised written annual rennrt and anneal re~nrt man 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 any necessary <br />changes: <br />Permittee Contact: CF.PR.contact first name <br />Permittee Name: Orlando & Rose Marie Martinez <br />Address: 1 Kiowa <br />Pueblo, CO 81006 <br />Phone Number: (719) 544-3237 <br />Fax Number: ¢7}9}-56fr-02-3Y'~r~ <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 />Stgnature of Corporate Officer, Own •, or Desi e <br />3-/~-aoa~ <br />Date <br />CF.PR.contact_last_name <br />M:U'ERM ITMASTERDOCUMENTSVv1-AF-01 <br />