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<br />~~ <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANN1iAi. FEF, and RF,PnRT RF.OiTF,ST <br />Thomas H. Smith <br />~M-2004-045 <br />Hanna Pit No. 1 <br />March 28, 2006 <br />$281.00 (Due on or before your anniversary date) <br />Rio Grande <br />RECEIVED <br />'' MAR 16 200& <br />/ Division ~f Miaerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, 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 />_~clamatiotLac.complished_to_date_a.,rl ~,~,ting the preceding_yearTnew_diaturbances-that-are-an[icipateil-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 revicad written annual re~nrt and anmral report man to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Thornas H. Smith <br />Permittee Name: Thomas H. Smith <br />Address: 1701 E. 147th Street <br />~ ~ouc~ LA!^r <br />t~o GkRNA/PAn/Cd7 LLG <br />P. o. ~3ox 88a <br />Kansas City, MO 64146 SOU / /7 ~iC ~, Cry O ~~~ <br />Phone Number: (816) 331-0435 7/9 O ~ - ~Q ~~ <br />Fax Number: (816) 331-2041 ~ r9) 8'73 -~0 5~f <br />--~ <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 enclosed. <br />Owner, or Designee <br />~ 3~5/aoo ~ <br />Date <br />t'h~ <br />