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NOV-21-02 76:26 FROII-Colorado 9lvition of tlinoralc & Gioloty +13038663567 7-676 P.003/003 F-253 <br />/~ <br /> pl\TTrrAi. FF,F, an RFPART, I~F{jTTFCT <br /> RECE9VED <br />PERMITTEE NAME: Elbert County <br />N~~ ` 2 2~~2 <br />PF.RtvI1T NO.: M-19&i-129 <br />OPl's1tATION NAME: Elbert County Pit Division of Minerals and Geology <br />ANNIVERSARY DATE: November 25, 2002 <br />ANNUAL FEE DUE: $6f3g.00 (Due on or before your anniversary date) <br />COUNTY: )ilbcrt <br />According to C.R.S. 3432.5-116 or C.R.S, 3h32-716, each year, on the anniversary date of the permit, an <br />operator shall subtnit the annual fee, a a~por and map shgwing 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 year, reclamation that will be performed Burin; the coming year, the dales for the <br />beginning of active opetarions, and the date active operations ceased For the year, if any. <br />Plasc attach vm~r rnviSe-? wrrtken aTTllpt tenors and annaat reAmrt man to tMc form- Please note char an <br />adequately labeled map that clearly delineates and includes the above elem..ents may suffice for a written <br />report, <br />Division records indicate the Following oermit[ee contact information. Please verify and make any necessary <br />changes: <br />Pernuttee Contact: Todd Ramer <br />Pet7ttittee Name: Elbert County <br />Address: 215 Comanche <br />P.O. Box 597 <br />~~ ~ 11(0 <br />K3ow3, CO 80117 <br />Phone Number. (303) 621-3153 <br />Fax Number: (303) 61-3154 <br />3-(0~~-31~(n <br />ff you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach i[ to this form along with your written repots and map. Atmual Report instructions arc <br />enclosed. <br />~1~~ <br />Sib afore of Corporate Officer, Owner, or Designee <br />Date <br />M~1PtikMRVAASTERaOLL'MFN'YS W-AF-0t <br />