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_.. <br />ANNUAL FEE and REPORT REQUEST <br /> <br />RECEI~/ED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />El Paso County <br />M-1995-095 <br />Simla Highway Pit <br />July 8, 2002 <br />$281.00 (Due on or before your anniversary date) <br />El Paso <br />JUL 0 8 2002 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-116 of C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />--operator shall-submit-the annual fee; a-report-and map-showing-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 yeaz, 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 yeaz, if any. <br />Please attach vour revised written annual report and annual report map 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: -Faui~ig~r- <br />Pemuttee Name: El Paso County <br />Address: 3460 N. Marksheffel Rd. <br />Colorado Springs, CO 80922 <br />Phone Number: (719) 520-6460 <br />G ~0~~~ P. 5~~~-es, <br />Fax Number: (719) 520-6460 (`714) S 20 - (fl ~"'7 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 />Signature f Corporate O icer or Owner <br />2 O /O Z <br />Dale ~ <br />M iPERMITVv1ASTERD000MENTSU1-AF-05 <br />