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..` <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Mesa County 'G " <br />M-1983-216 / <br />Lumsden Canyon Pit <br />June 11, 2005 <br />~, ~. <br />- <br />JUN 2 ? ZppS <br />~:,... ~. <br />/V <br />$281.00 (Due on or before your anniversary date) <br />Mesa <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 ymlr revised written annual rem and annnal re,Pnrt mare to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bud Thompson <br />Permittee Name: Mesa County <br />Address: 1000 S. 9th St. <br />P.O.Bax 20000-5025 <br />Grand Junction, CO 81501-5025 <br />Phone Number: (970) 244-1811 <br />Fax Number: (970) 256-1411 <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 />`S~ignat-ur-enof Corporate Offi er, Owner, or Designee <br />Date <br />M:~PEAMITVv1ASTERDOCUMENTSUI-AF-04 <br />