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• ~II ~I~II~~I~~~~~ ~~~ <br />ANNUAL REPORT <br />PERMITTEE NAME: Kiowa County <br />PERMIT NO.: M-1985-173 <br />OPERATION NAME: Rother Gravel Pit <br />ANNNERSARY DATE: February 3, 2000 <br /> <br />REG~\V~o <br />~pN 1 ~ ~'~~o eo~y <br />o\~~o~o`~\~i~ <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $550.00 '~j 1 ,~. <br />COUNTY: Kiowa .~ <br />~' <br />According to C.R.S. 34-32-116(3)(a), each year, on fhe anniversary dale of the permit, an - <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that aze anticipated to occur during the upcoming yeaz, reclamation that will be <br />performed during the coming year, the dates for [he beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this annual tenor[. <br />Please mote that an adequately labeled map drat clenrly delineates and includes the above <br />elements may suffice for a tivritten report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Cnn[;tct Namc: Mike Splitter <br />Address: Kiowa County <br />PO Box <br />Eads, CO 81036 <br />~~~nnh;uty: Kiowa County <br />Phone No.: ( 719 1 438-5810 <br />FAX No.: ( 719 ) 438-5327 <br />If there are additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />Signature of Corporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />M ~PERMnU1ASTERD000MENTSU7~AF-07 <br />