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a <br />" 1 V~ <br />R~'iC:~~~'~~ <br />APR 2 0 1004 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Walsenburg Sand & Gravel, Inc. <br />M-1978-283 <br />Sand Arroyo <br />April 24, 2004 <br />$281.00 (Due on or before your anniversary date) <br />Huerfamo <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 operator <br />shall submit the annual fee, a report and map showing the extent of current 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 the date active operations ceased for the year, if any. <br />Please attach ym~r revised written annnal reps and anm~al report main fn this 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: Louis Vezzani <br />Pennittee Name: Walsenburg Sand & Gravel, Inc. <br />Address: Hwy. 10 <br />Walsenburg, CO 81089 <br />Phone Number: (719) 738-1883 <br />Fax Number: (719) 738-1883 <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 of C rporate Officer, Owner, r esignee <br />/~ - U <br />Date <br />