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f~~ <br />b~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />t/ ANNiiAT, FF.F, and REPORT RF.nTIF.ST <br />/Fremont Couuty <br />M-1990-047 <br />Quargmire Creek <br />January 20, 2006 <br />RECEII/E~J <br />'~ FEB 0 31006 <br />/ Oiuision of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Fremont <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 <br />---~-operator-skall-submit-the-snnual-fee; a-report-and-map-showing-the=extent-of-current-disturbances-to.affected--_ <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to I <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal rennrt and anneal rennrt m~ to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Paul Garrett <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Fremont County <br />Fremont County Commissioners <br />615 Macon Ave., Room # 105 <br />Canon City, CO 81212 <br />(719)942-4234 <br />(719)275-7626 <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 <br />enclosed. <br />~~ <br />Signature of Corporate fficer, Own r Designee <br />/~~/3~~s <br />Date <br />M:~PERMITNrASTERDOCUMENT5IM-AF-04 <br />