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<br />ANNiTAi, FF.F, and REPORT RF.niTF.ST <br />PERMITTEE NAME: Kiowa County ~~~~' V~,~ <br />PERMIT NO.: M-1985-173 JAN 15 ~ <br />OPERATION NAME: Rother Gravel Pit Division of <br />ANNNERSARY DATE: February 3, 2004 Mine`a~s and Ceoiogy <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Kiowa ~ 5 <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />_ _ c~gerator_shall ~ubmit.the annual~'ee,arepoct_and_map_showinprthe_extent-of-current-disturbances to affected - - - <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <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 annual rennrt and annnal rennrt maw 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: Richard McDaniel <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Kiowa County <br />P. O. Box 100 <br />Eads, CO 81036 <br />(719) 438-5810 <br />(719)438-5327 <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 />~a <br />Signature o Corporate Officer, Owner, or Designee <br />-s2- G~ <br />Date <br />M:WERMIThfASTERDOCUMENTSNr-AF-04 <br />