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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Park County <br />RECEIVED <br />APR 0 9 2003 <br />M-1995-021 <br />Chaparral Pit <br />Apri124, 2003 <br />Division of Minerals and GeolaeY <br />$281.00 (Due on or before your anniversary date) <br />Park <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_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 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 annual report and anneal re~nrt m P 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 /> <br />Permittee Contact: Doug Keith i <br />Permittee Name: Park County <br />Address: P.O. Box 147 <br /> Fairplay, CO 80440 <br />Phone Number: (719) 836-4270 <br />Fax Number: (719) 836-4275 <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 />Officer, Owner, or Designee <br />M:\PERM ITMASTERDOCUMENTSVvi-AF-04 <br />