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-~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kiowa County <br />M-1991-078 <br />Peters Pit <br />February 4, 2004 <br />~~~~~ ~~~ <br />SAN <br />Division°JM.°e't~ ~Q~ <br />~ept09Y <br />$281.00 (Due on or before your anniversary date) <br />Crowley ~ ~j <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 s ali sdbmitthe-annual fee,-a-report-and-map_sho~adngshe_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 opemtions, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal report and annnal rennrt main, 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: Rick Spady <br />Permittee Name: Kiowa County <br />Address: <br />Phone Number: <br />Fax Number: <br />P. O. Box 100 <br />Eads, CO 81036 <br />(719)438-5810 <br />(719) 438-5327 <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 />~ ~~~~ <br />ature of~rporate Officer, Owner, or Designee <br />~ ~ !~ 0~ <br />Date <br />M:IPEAMrM1AS7ERDOCUMENTS~M-AF-04 <br />