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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Louisiana Land and Gravel Company, LLC <br />M-2000-049 <br />Angie Pit <br />April 9, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Montrose <br />~~~C;~li/ED <br />MAR 2 7 2003 <br />Division of Minerals and GealogY <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 />shall submit the annual fee a report and man showine the extent of current di~_rbances to af~cled 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 annnal report and anm~al rennrt mgp to this form. Please note that an <br />adequately /abeledmap that clearly delineates and includes the above elements may suJfcefor a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Michael A. DeJohn <br />Petmittee Name: Louisiana Land and Grave] Company, LLC <br />Address: P.O. Box 8419 <br />Clinton, LA 70722 <br />Phone Number: (225) 683-3358 <br />Fax Number: (225) 683-3802 <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. Annua] Report instructions are enclosed. <br />~. ~~ <br />Signature of Corporate Offid~r, Owner, or Designee <br />~11,1~~ <br />Date <br />MiPERMnVNASTERI7000MENTSU7-AF-01 <br />