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t~ <br />RECEIVED <br />SEP 1 22003 <br />0(Illilon of Minerals and Geob~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Tarorock Gravel I <br />M-2001-068 <br />Bottomless Pit <br />i <br />September 17, 2003 <br />i <br />$688.00 (Due on or before your anniversary date) <br />i <br />Las Animas- - 1 <br />I <br />According to CR.S. 34-32.5_1 ]6,o~C.R.S..~4,32-116, each year, otithe anniversary_date-ofthe_permit,_an operators _ _- <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 note that an <br />adequately labeled map that clearly delineates and includes the aboi e 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 />J <br />I <br />Permittee Contact: Brent Tamburelli ~ <br />Permittee Name: <br />Address: <br />- -_-.--~Phone•Number: <br />Fax Number: <br />Tarorock Gravel <br />137 Plum <br />Trinidad, CO 81082 <br />(719)846-3034 <br />(719)846-3034 <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />i <br />i <br />Signature of Corporate Officer, Owner, or Designee <br />g~~`~ <br />Date <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />M1PERM ITVv1ASTERDOCUMENTSUI-AF-01 <br />