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RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Thornburg Family Limited Partnership <br />M-1983-060 <br />Thornburg Pit <br />September 27, 2002 <br />SEP 7 0 1Q02 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Adams <br />According [o 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 ee a reoort and man chowinc* the eX[en[_of_cuttent_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 [he date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map 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: Stanley Thornburg <br />Permittee Name: Thomburg Family Limited Partnership <br />Address: <br />Phone Number: <br />Fax Number: <br />50747 E. 38th Ave. <br />Bennett, CO 80102 <br />(303)644-3424 <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 C orate Officer, Owner, or~esignee <br />~~ 7 0~ <br />Date <br />M:iPERMI'IU1ASTERDOCUMENTS W/-AF-OI <br />