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999 <br /> ANNUAL FEE and REPORT REQUEST RECEIVED <br /> PERMaTEE NAME: Forest Lakes Metro District JAN 16 2001 <br /> PP'RMIT NO.: M-1981-158 Division of Minerals and Geology <br /> OPERATION NAME: Forest Lakes Pit#1 <br /> ANNIVERSARY DATE: January 26, 2001 <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: La Plata <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 /> 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 operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual report and annual report map to this form. Please nose char an <br /> adequately labeled map Thal clearly delineates and includes lire 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: Dale Kortz <br /> Permittee Name: Forest Lakes Metro District <br /> Address: P.O. Box 440 <br /> Bayfield, CO 81 122-0440 <br /> Phone Number: (970) 884-29:15 <br /> Fax Number: (970) 884-0305 <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 /> E <br /> . <br /> krAw./prX <br /> Si7'a, <br /> re Corpora" O ficer or Owner <br /> s/ <br /> D to <br /> M.�PERMITh1 ASTER DOCIJSIENTSVN-AF-04 <br />