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s ss <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Montrose County <br />M-1984-152 <br />Grizzly Ridge Pit <br />September 27, 2004 <br />N~ <br />RECEIVED <br />SEP 13 2004 <br />Division of Minerals & GeoloBY <br />$281.00 (Due on or before your anniversary date) <br />Montrose <br />- According to C.R:S:-34=32:5-I'16-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-precedingyear; 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 ymrr revised written annual repprt and annual report 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: Brian Wilson <br />Permittee Name: Montrose County <br />Address: 161 S. Townsend <br /> Montrose, CO 81401 <br />Phone Number: (970) 249-7755 w _r___`~ 7 ~ ' ~5 ~ - ~ OOd <br />Fax Number: (970) 249-7761 q 7 0 - a 5 a - '101 ~ <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 />Si re of Corporate Officer, Owner, or Designee <br />~/i, / a~ <br />Date <br />M:~PERMITNIASTERDOCl1MEMSUI-AF-04 <br />