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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />ANNUAL FEE and REPORT REQUEST <br />Huerfano County <br />M-2001-106 <br />Orlando Pit <br />December 18, 2002 <br />RECE/yED <br />~C 1 Z Z~i7Z <br />Ut°istort •/Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Huerfano <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 pernvt, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Drew Nigrini <br />Pernlittee Name: Huerfano County <br />Address: 401 Main St., Ste 201 <br />Walsenburg, CO 81089 <br />Phone Number: (719) 738-2370 <br />Fax Number: (719) 738-3996 <br />Rill RrnnPlli <br />Huerfano County <br />1038 Russell <br />al~~nburg, rn R1nR4 <br />719-738-2420 <br />Same <br />If you have additional comments and/or information that should be provided to the Division, please provide i[ <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />~~ ~ ~ <br />Signature of Corporate f er, Owner, or Designee <br />Oress:;7. DeHerrera <br />1 'Z -~ • \ - a 2_ <br />Dale <br />M:~PERMITMASTERD000MENTSUI-AF-01 <br />