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999A. ������ ��� <br /> ANNUAL FEE, and REPORT REQUEST <br /> I'ERMI'r'I'EE NAME: Bumgarner Ranches REC�,v GD <br /> PERMIT NO.: �l� 'AN 1 y 100� <br /> AONNIVERON NAME: Brig Pit SARYDATE: February 2,2001 O,Y`St000tM�p6�atsaod�oo�o9't <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Grand <br /> According to C.K.S. 34-32.5-116 or C.R.S. 34-32-116, each. year, 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 /> Iand, reclmnation 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 li r the <br /> beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual report and annual report man to this form. !'lease note that an <br /> adequately labeled map that clearly delineates and includes the above elements may .wJJicc• (Ira written <br /> report.. <br /> Division records indicate the following pennittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Gary Bumgarner <br /> Permittee Name: Bumgarner Ranches <br /> Address: P.O. Box 186 <br /> Kremtnling, CO 80459 <br /> Phone Number: (970) 724-9224 <br /> Fax Number: <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 /> 1 <br /> Sy a ture ofyorporate Officer or Owner <br /> f:2/ O/ <br /> Date <br /> M:TFR MIIWASTE RDOCUMF.MS\M-AF-01 <br />