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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANN]VERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Delta Sand & Gravel Company <br />M-1977-020 <br />Pit No 1 <br />March 23, 2002 <br />RECEIVED <br />MAR 1 12002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Delta <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances 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 the beginning <br />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 report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Miclaaet-L-Kipp <br />Permittee Name: <br />Address: P.O-Eex-}@3' <br />G~.._.l. J+..... ~o.,, rW 815UZ <br />Phone Number: io~~`T <br />Fax Number: (so`Z9)-5-74-83-26 <br />{`ACS. l~a~ 366`7 <br />C4~o~ zK~• K~tvo <br />(470 z k3- 54 KS <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Sigciatur~'6f Coi o to Officer or Owner <br />fY~i~~~ti ~~z001- <br />Date <br />M:IPERM ITMASTERDOCUM ENTS~h1-AF-01 <br />