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.bt~~,~ <br />vANNiiAi, FF.F. and RF.P/lRT RF.OiiF.ST <br />PERMITTEENAME: ,/ <br />CrowleyCounty REC~iu~D <br />PERMIT NO.: / <br />/ M-1982-126 'APR 0 ~ 2006 <br />OPERATION NAME: Crowley Cnty Grav 2 <br /> V ot`mpn of Minerals and GeolopY <br />ANNNERSARY DATE: Apri128, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Crowley <br />M <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 anneal report and annual repo' rt man to this form. Please note [hat 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: <br />Permittee Name: <br />Address: <br />Mike Apker <br />Crowley County <br />603 Main St. Ste. 2 <br />Ordway, CO 81063 <br />Phone Number: (719) 267-4444 <br />Fax Number: (719) 267-3114 <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 />~(.~C.lr C/~~/ <br />Signature of Co orate Officer, Owner, or Designee <br />~- l~ - D(Q <br />Date <br />M:~PERMI'I\MASTEItDOCUMENTSUI-AF-04 <br />