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,~-o~~ <br />RECEI~iEC <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Raymond C. Petersen <br />M-1981-236 <br />Colorado River Ranch Gravel Pit <br />March 29, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Grand <br />FEB 17 2004 <br />Division of Minerals & 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 />rsclamaN~*+ ~~csr' 1?n iehed-ro date and durine the preceding ear, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ~r reviced written anmral re,Pnrt and annual re~nrt man 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: Raymond C. Petersen <br />Permittee Name: Raymond C. Petersen <br />Address: P. O. Box 832 <br />Kremmling, CO 80459 <br />Phone Number: (970) 724-9327 <br />Fax Number: (970) 724-9327 <br />If you have additional wtmnerSts 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 />Owner, or Designee <br />a <br />