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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Jefferson County <br />M-1977-245 <br />Pine Junction Pit <br />January 31, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Jefferson <br />RECEIVED ; <br />JAN 2 4 2003 <br />Division of Minerals and Geology <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 />-- - -tand,-reclamazion-accomplished ro°date and during the preceding year,-new disturbances-that-are-anticipated-to- <br />occur during the upcoming yeaz, reclamation that will be performed during the coming yeaz, the dates for the <br />beginning of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attarhTonr revised written annual rennet and annual repp tr _ marn 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 />Permittee Contact: Paul G. Rice <br />Permittee Name: Jefferson County <br />Address: 21401 Golden Gate Canyon Rd. <br /> Golden, CO 80403-8108 <br />Phone Number: (303) 271-5205 <br />Fax Number: (303) 271-5222 <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 />~~d <br />Signature of Corporate Officer, Owner, or Designee <br />~uw,uf ...~ 11 , ~ a e 3 <br />Date <br />M 1PERM17N1ASTER000UMEIVTSN1-AF-04 <br />