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NCO <br />RECEIVE® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rowe Gravel <br />M-1999-038 <br />Rowe Gravel <br />September 21, 2004 <br />$281.00 (Due on or before your anniversary date) <br />La Plata <br />SEP 15 ~ <br />awisinn 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 />rcc}arrariorraccompiisheu to-daie-and-during-the=preceding yeer,-new di"sturlianoes that aie anti"ctp`ated'to occur --v <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 ynnr revised written anneal re~nrt and anneal rennrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Brad W. Rowe <br />Permittee Name: Rowe Gravel <br />Address: 9134 CR 100 <br />Hesperas, CO 81326 <br />Phone Number: (970) 588-2277 <br />Fax Number: _ _ _ _ _ _ _ <br />IVo Gho. ,na L <br />1f 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 />Signature of Corporate Officer, Owner, or Designee <br />Se,w~ - ~~ o~{ <br />Date <br />~~,°~ ck~ 26?1 <br />