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~~ ANNiJAT. FF.F, and RF.PnRT RF,~iTFST <br />PERMITTEE NAME: Grand County APR 3 0 ZGG4 <br />PERMIT NO.: M-1984-156 <br />Division of Minerals & GeoloGT <br />OPERATION NAME: Grand Cnty No 201 aka Scholl Gravel Pit <br />ANNIVERSARY DATE: May 29, 2004 <br />ANNUAL FEE DUE: $688.00 (Doe on or before your anniversary date) <br />COUNTY: Grand <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 current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />-- ' -occur Suring the upcoming year,-rectamation-thatwill be performed during the-coming year,-the dates-fer-the- - - <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal re~nrt and annnal report main 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: M C. Branstetter <br />Permittee Name: Grand County <br />Address: 467 E. Topaz Ave. <br />Phone Number: <br />P.O. Box 9 <br />Granby, CO 80446 <br />(970)887-2123 <br />Fax Number: (970) 887-3168 <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 />7 // d~/ <br />ign~ature of Corporate f ~cer, Owner, or Designee <br />y/ o~ <br />Dat <br />M:~PEAMITNIASTERDOCUMENTSN7-AF-00 <br />