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RECEIVED <br />PERMITTEE NAME: <br />PERMfI' NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REpUEST <br />Delta County <br />M-1978-304 <br />Triantos Gravel Pit <br />November 13, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Delta <br />OCT 11 1002 <br />Division of Minerals and Geology <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 shall-submit -the annual-fee, a report and map showing [he extent-of current disturbances [o 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 your revised written annual report and annual report mad 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: Larry Record <br />Permittee Name: Delta County <br />Address: 501 Palmer St., Ste. 227 <br />Delta, CO 81416 <br />Phone Number: (970) 874-2100 <br />Fax Number: (970) 874-21 14 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach i[ [o this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />`' 'fie,~'~~ <br />Signature o orporate Officer, Owner, or Designee <br />/ p-/ S- 0 2_.- <br />Date <br />M:~PERMI"I~MASTERDOCUMENTSVN-AF-04 <br />