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RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />San Miguel County <br />M-1989-030 <br />Zadra Pit <br />May 15, 2002 <br />MAY 1 7~ 2002 <br />/ ~l <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />San Miguel <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 <br />_ _operator shall. submit the annual fee, a report and map showing the_extent_of-currenGdisturbances to-affected- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <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 maa to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: Mike Horner <br />Permittee Name: San Miguel County <br />Address: P.O. Box 426 <br />Phone Number: <br />Fax Number: <br />Norwood, CO 81423 <br />(970)327-4835 <br />(970)327-4090 <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 <br />enclosed. <br />~y~ i~~-' <br />Signature of orporate Officer or Owner <br />S•/S/.e7 <br />Date <br />M: W ERMITMASTERDOCUM ENTSVvi-AF-04 <br />