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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~9~iKi~r <br />' H//scold A Winter <br />~'M-1985-165 <br />Winter Ranch Pit <br />November 26, 2005 <br />~mk <br />RECENED <br />~~~~s~ <br />$281.00 (Due on or before your anniversary gFly~~, of Minerals and Geotogy~ <br />Las Animas <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 />Pease attach ypnr revised written anm~al rennrt and anmral re n~,~rt m~ 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: Harold A. Winter <br />Permittee Name: <br />Address: <br />Harold A Winter <br />20157 CR 75.0 <br />K <br />Trinidad, CO 81082 O ~~ <br />Phone Number: (719) 846-35.70 O ~'+ <br />Fax Number: /yo N (L <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 />Si ature of Corporate Officer, Owner, or Designee <br />V~r~v f 5 , 7_r'Y15 <br />Date <br />