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•~ ~.. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />M Peter Schrepfer <br />M-1994=006 <br />Emerald Vista Estate <br />March 11, 2004 <br /> <br />'h%n <br />e~d~sg,~Ce%g <br />$281.00 (Due on or before your anniversary date) ~ <br />Las Animas <br /> <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />Shall aubmit_the_annnal fee a n~pnn d r h s ^~~^--sv*°-,.~.-:-.,~^r : ~. °^' -a~.~.,.-e.ni~-~,ansea--to-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 [he beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annnal re~nrt and annnal re~nrt main to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Frank Leone, Jr. <br />Permittee Name: M Peter Schrepfer <br />Address: 502 S. Walnut <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-4170 <br />Fax Number: (719) 345-0605 <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 wok- ~ ~ ~~ n o (e o n bQ~` . <br />Signature of Corporate Officer, O ner, or Designee <br />Date <br />