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' ~- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />City of Colorado Springs <br />M-1989-116 <br />Crystal Pit <br />March 26, 2005 <br />$281.00 (Due on or before your anniversary date) <br />Teller <br />t`wit`;. -.` _: <br />APr~, 1 E 2C05 <br />7ivisln,.: ..:.._. <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 snail submit-the annual fee; a report end map showing the extent ot~ 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 ynnr revised written anm~al rennrt and annnal r~nrt to thix form. 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: Dave D. Jordan <br />Permittee Name: City of Colorado Springs <br />Address: P.O. Box 1575 <br />Mail Code 060 <br />Colorado Springs, CO 80901-1575 <br />Phone Number: (719) 385-7715 <br />Fax Number: (719) 684-2234 <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 />i <br />~~ ~P <br />Signature of Corporate Officer, Owner, or Designee <br />s/~~~~ <br />Date <br />M:NEAMIT~MASTEADOCUMEMSN1-AF-04 <br />