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<br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Fremont County <br />M-1994-118 <br />Phantom Canyon Pit <br />August 8, 2003 <br />AUG 0 6 2003 <br />llirision ~t Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Teller <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 s a su mn t e annuarfee, a report an map s owing 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 attach your revised written anneal report and anmral rPpnrt main to this fnrm_ please note that 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: CF.PR.contact_first_name <br />Paul Garrett <br />CF. PR.contact_last_name <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room #105 <br />Canon City, CO 81212 <br />Phone Number: <br />Fax Number: <br />(719)276-7320 <br />(719)275-7626 <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 />Sign re of Corporate Officer, Owner, or Designee <br />7~ ~, ~ ~ 03 <br />Date <br />M~IPERMITU1ASTERDOCUMENTSNI-AF-04 <br />