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iiiniii <br /> ANNUAL FEE and REPORT REOUEST RECEIVED <br /> PERMITTE.E NAME: Fremont County JAN 2 2 2001 <br /> PERMIT NO.: U4990-W fAelslon of Minerals and Geology <br /> OPERATION NAME: Quargmire Creek <br /> ANNIVERSARY DATE: January 20, 2001 <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Fremont <br /> According -:o 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 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 Garrett 1424n4r TIC , K'^ k I'C u <br /> Permittee Name: Fremont County PO_ i3 o-' 3 3 V <br /> Address: 615 Macon Ave., Rm. 102 Cc, 1p1 <br /> Canon City, CO 81212 <br /> Phone Number: (719)942-4178 <br /> Fax Number: (719)942-4178 <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 /> Signature o^ Corporate Office or Owrkr <br /> � I'•f�O1 <br /> Date <br />