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<br />RECEIVED <br />JUL 2 2 2003 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Jordan C. and Jone L. Burdick <br />M-1987-092 <br />B & G Stone <br />August 25, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Larimer <br />Division ~i Minerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator _ <br />shelf snbmii the aniiual-fee-a report and map showing the extent of-current disturbances fo affected land <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annnal rennrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jordan C. Burdick <br />Permittee Name: Jordan C. and Jone L. Burdick <br />Address: P.O. Box ]385 <br />Lyons, CO 80540 <br />phone.Number: ~ .(3D3)_823-59.43 <br />Fax Number: <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 enclosed. <br />_ l/.yo_ ~~GCLC.f'C P <br />i-Signature of Corporate Officer, Owner, or Designee <br />~/~ ,Z ~~ <br />Date <br />M:~PERMITMASTERD000MENTSU~YAF-01 <br /> <br />^ <br /> <br />