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~ III IIIIIIIIIIIIIIII ~ <br />ANNUAL REPORT <br />PERMITTEE NAME: Rio Blanco County <br />PERMIT NO.: M-95-046 <br />OPERATION NAME: Johnson Draw <br />ANNNERSARY DATE: October 07, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUNTY: Rio Blanco <br />,~-~111 <br />~G~~~Eo <br />~ r ~So~ 1 <br />;S\ no ~~ta~~G~~Y <br />.~ <br />According to C.R.S. 34-32-116(3)(a), 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 <br />to affected land, reclamation accomplished [o date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />annual report. Please note that an udequateh lnGeled map lour clearly delineates mrd <br />includes the aboi~e elements may suffice fog' a written repot(. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: S fa.~ ~~ I, Jr /r'asi.e a s.~e n Company: /~(~, ~p ,~~~ ra YI 2 0 ~'d lA 41 ~/ <br />Address: / ~ ~/ 9 9 /'/, tvo .~G ~ Phone No.: (~/'0 ) (7S ~ ~ZG1tN <br />~~~~r~(~e~arPC>o Q(G1~,~ FaxNo.: 990 ) r"9.S-S,~/~ <br />If there are additional comments and/or information that should be provided to [he Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />~~~.~ - ~~ - rte, ~..,~..., S = /C ~ ~ cI <br />Signature of rpora[e Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />