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• iii iiiiiiiiiiiu iii <br />., <br />ANNUAL REPORT <br />PE:RMITTEE NAME: Florence Sand & Gravel <br />PERMIT NO.: M-92-051 <br />OPERATION NAME: Florence Sand & Gravel Pit <br />ANNNERSARY DATE: August 11,1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUNTY: Fremont <br />~° ~® <br />REC~~~~~ <br />Division U( 3 G 19y9 <br />olMineray & Georo9% <br />According to C.R.S. 34-32-116(3)(a), 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 <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that aze anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming yeaz, the dates for the beginning of active operations, and the date <br />active operations ceased for the yeaz, if any. <br />Please attach your revised annual report map and written report to this <br />annual report. Please note that an adequately labeled mnp that clearly delineates and <br />includes the above elements may suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: ~PL ~odA r m e L <br />Company: ~/nrence and f Gra~eL, <br />Address: ~ 9~ 5th St~ <br />TPnroSP C~0• S/a~0 <br />PhoneNo.:(']/9 ) 7~rw- `~~SS <br />Fax No.:~'7/ 9 ) 78'!- 3 a ~ ~ <br />If there are additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />Signature of Corporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />