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6111/~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ANNiJAI, FF,F, and RF,PORT RF,~JIF.ST <br />/Cecil C Powell <br />M-1995-012 <br />Powell's Gravel Pit <br />May 12, 2006 <br />$281.00 (Due on or before your anniversary date) <br />Moffat <br />FiECEEVED <br />APR 11 2006 <br />vUiYisiort •f 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 [hat 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 your revised written annnal report and annnal re~nrt m to 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: Cecil C. Powell <br />Permittee Name: Cecil C Powell <br />Address: P.O. Box 23 <br />Dinosaur, CO 81610 <br />Phone Number: (970) 374-2329 <br />Fax Number: <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 />c~...,.~.~ ~~ <br />Signature of Corporate Officer, Owner, or Designee <br />~r B <br />Date <br />