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_r <br />>- / v <br />~. Gas ~/~ <br />ANNTIAT. FF,F, and REPORT RF,nTTF.ST 4 v <br />RECEtl~':' <br />PERMITTEE NAME: Morgan County ~R 2 3 <br />PERMIT NO.: M-1979-210 <br />DIrISIOn of Minerals end Oem;ey <br />OPERATION NAME: Vancil Pit <br />ANNNERSARY DATE: May 4, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Morgan <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 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 attarh ynnr revised written annual rennrt and anneal reDnrt m:~ to this form. Please note tha[ 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 pemrittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joe B. Baltazar <br />Pennittee Name: Morgan County <br />Address: 17303 CR S <br /> Fort Morgan, CO 80701 <br />Phone Number: (970) 562-3560 <br />Fax Number: (970) 562-3569 <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 />afore of Corporate Officer weer, or Designee <br />Date <br />M1PERMINAASTERD000MENTSM-AF-04 <br />