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08/11;2004 15:28 FAX 719 8467842 <br />PERMITTEE NAME: <br />PERMIT NO.. <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL PEE DUE: <br />COUNTY: <br />Brent Tamburelll <br />Tamrock Gravel <br />A'1-2001-068 <br />Bottomtess Pit <br />September 17, 2004 <br />FiEGEI!/ED <br />s~P o a zooa <br />Division ci Mi~.c:eta & Geology <br />5688.00 (Due on or before your anniversary date) <br />l.as Animas <br />r~oo~ <br />I <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, _ <br />--'-~ -rcclamatiotraccomptishtrd to' date an3 during the preceding yeai, new~dishubances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of activC operations, and the date active operations ceased for the year, if any. <br />Please attach yni~rPXiaed written annual rc~( and snnnal~ n~ M m~tn thin form ple4se note that an <br />adequately labeled map lhat 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: Brent Tamburelli <br />Pe[ntittee Name: Tamrock Gravel <br />Address: 137 Plum <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-3034 ~/ <br />'Fax Number: {~}}~84tr30g4- hr~/ ~ 7~9~ ~y~ 7~y2 <br />>f 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 />~_~ ~~ <br />Signature of Corporate Offi er, Owner, or Designee <br />Date <br />