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10/20/2003 11:32 FAX 720 283 2025 MISKEN INSURANCE <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Douglas County Sand & Gravel, LLC <br />M-1983-089 <br />Douglas County Sand & Gravel <br />November 8, 2003 <br />X00 <br />V <br />RECEIVED <br />JAN 2 ~ 2004 <br />Division vi Minerals & 6evtopy <br />$688.00 (Due on or before your anniversary date) <br />Douglas <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 operator <br />- -- shalh-submit--the-annual--fee, a report and map showing-the extent of current disturbances-to affected land, ..- <br />reclamation accomplished to date and during the preceding year, new dismrbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />gJease attach your revised written anmral reFnrt and annual re~nrf m r fn this form. Pease note that an <br />adequately laheled map that clearly delineates and includes the above elements may suffice for a written report, <br />Division records indicate the following permitiee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tim Misken <br />Permittee Name: Douglas County Sand & Gravel, LLC <br />Address: 5360 Sunset Dr. <br />Littleton, CO 80133 <br />Phone Number: (303) 797-6013 <br />Fax Number: <br />_~- <br />0~0o s . W~r.cax 5-r. <br /># ~~ <br />,~s~-ie ~c.~ , c~~) man e o 4- <br />~ ~_ <br />3a~ - __ Sao <br />If you have additional continents and/or information that should be provided to the Division, please provide i[ <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Utticer, Uwner, or lleslgnee <br />Date <br />M.IPERM77M4ASTERD000MENTSIM-AF-U~ <br />