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.~ <br />_ .. ~ ~ _ • <br />~II~~ I~~ <br />II IIIII <br /> ~II <br />~ <br /> ANNUAL FEE and REPORT REQUEST <br /> 0 <br /> ,_ <br />RED: ~ VED ~ <br />PERMITTEE NAME: Montrose County ~ <br />PERMITNO.: M-1983-148 ~~ ~ ' ,i ~~Q W c <br /> U ~ <br />OPERATION NAME: Neal Pit <br />~Ivision of ia~~.... env S.nlogy <br />W w <br />p <br /> ~ <br />ANNIVERSARY DATE: January 30, 2001 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <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 [he 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 vour revised written annual report and annual report mao to this form. Please note tl:a[ an <br />adequately labeled Wrap [hat clearly delinecr[es and nrchrdes [!re above elemerns 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 />Perrnittee Contact: Brian Wilson <br />Permittee Name: Montrose County <br />Address: P.O. Box 1289 <br />Montrose, CO 81402 <br />Phone Number: (970) 249-9791 <br />Fax Number: (970) 249-6680 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach i[ [o [his form along with your written report and map. Annual Report instnrc[ions are <br />enclosed. <br />~ ~~ <br />gnature of Corporate Officer or Owner <br />Date <br />a <br />0 <br />d <br />co <br />a <br />a <br />.y <br />j <br />a <br />M NERMI"I V.IASTERD000MENTSVN-AF-OJ <br />