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-.: <br />,.. <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Morgan County <br />M-1979-210 <br />Vancil Pit <br />May 4, 2003 <br />APR 2 5 2003 <br />Division ~f Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />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 />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 ym~r revised written annual rennrt and annual renort maw to this form- Please note that an <br />adequately labeled map that clearly delineates and includes Jhe above elements may suffrce 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: Joe B. Baltazar <br />Permittee Name: Morgan County <br />Address: 17303 CR S <br />Ft Morgan, CO 80701 <br />Phone Number: (970) 867-9446 ~ 9 90 ~~ ~ - 3 sl CJ <br />Fax Number: (970) 867-5264 ~~ ~ $ y a. ; ;3.5"" ~z,9 <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 />~gnature of Corporate Off~f r, Owner, or Designee <br />`fl~~103 <br />Dale <br />M:~PERMITUTASTERDOCUMENTSVvi-AF-04 <br />