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<br />~~~ ~ <br />PERMITTEE NAME: vJghn R. Kurtzer RECEI VEp <br />PERMIT NO.: <br />OPERATION NAME: M-2002-053 <br />Kurtzer Pit ~CT' 4 ~r <br />~' `wJ <br /> <br />ANNIVERSARY DATE: <br />November 27, 2005 Division o/Minerals and GaalaBy <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Phillips <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 />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 anneal report and anneal report m ~n to Chic form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact John R Kurtzer <br />Permittee Name: John R. Kurtzer <br />Address: 24463 CR 11 <br />Haxtun, CO 80731 <br />Phone Number: (970) 774-7122 <br />Fax Number: (970) 774-3265 <br />If you have additional comments and/or information that shoul <br />below or attach it to this form along with your written report and <br />Si tore of Corporate O facer, O ier, or Designee <br />~~~~~/ S, <br />Date <br />~ P6'- <br />~s~ ~U <br />~r~s <br />w2S rt°~o~~~ <br />it <br />