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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Sanborn Sand and Gravel <br />M-1984-094 <br />Gloria Z Mine <br />July 17,2003 <br />$688.00 (Due on or before your anniversary date) <br />Park <br />RECEIVED <br />JUL 0 8 2003 <br />Division of latgerals and Geola~y <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 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 ynnr revised written annual rennrt and annual re nrt main 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: -~dy~bern- <br />Permittee Name: Sanborn Sand and Gravel <br />Address: 2001 Platte Dr. <br /> <br />Fairplay, CO 80440 <br />Phone Number: ~(~9}$3Cr-240E~ ~/~~ - ~~ ~ -- Q~y~ <br />Fax Number: ~}79j-5~T9T~'9 ~ ~Q -~3 ~- O~~/Q <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 enclosed. <br />c <br />Signa re of Co rate Officer, Owner, or Designee <br />~/~03 <br />Dat-~~ <br />Sai- i~-~4im3 <br />M:~PERMITVvIASTERDOCUMENTSU~I-AF-OI <br />