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<br />PERMITTEENAME: City of Lamar R~~~'~~® <br />PERMIT NO.: M-1984-154 <br />OPERATION NAME: Well Field Pit DEC 0 4 2003 <br />ANNIVERSARY DATE: December 10 2003 <br />' <br />Division of Minerals and fieoloa~~ <br />ANNUAL FEE DUE: $251.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <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 y~n~r revised written anm~al re~nrt and anneal r~nrt m ~° to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Patrick Mason <br />Permittee Name: Ciry of Lamar <br />Address: 102 E. Parmenter St. <br />Lamaz, CO 81052-3239 <br />Phone Number: <br />Fax Number: <br />(719)336-4495 <br />(719) 336-4404 <br />If you have additional comments and/or information that should he 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 />Signature of Corporate Officer, Owner, or Designee <br />II~~~-~~ <br />Dale <br />M:\PERh1ITU9ASTERD000MENT5IM-AF-04 <br />