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PERMTfTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Duckels Construction, Inc. <br />M-1976-OSl <br />Bettger Gravel Pit <br />May 8, 2004 <br />REGE~~E® <br />JUN ? 5 2004 <br />Givision of Minerals & GeoloBY <br />$688.00 (Due on or before your anniversary date) <br />Routt <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 da*,e-ard-during-the-preceding-year;-newdisturbances-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 your revised written annual r~nrt and anmral report manrtn 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: Fred A. Duckels <br />Permittee Name: Duckels Construction, Inc. <br />Address: 3500 Duckels Ct. <br />Steamboat Springs, CO 80487 <br />Phone Number: (970} 879-6072 <br />Fax Number: (970) 879-6748 <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 />~~~~ .~~ <br />Si afore of Corporate Officer, Owner, or Designee <br />Date <br />