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<br /> ANNiiAi. FF.F. and RF.PnRT RF.t7i TF.ST <br />R~CEtf ~E® <br />PERMITTEE NAME: City of Colorado Springs <br />PERMIT NO.: M-1989-116 A <br />~"R 2 3 <br />OPERATION NAME: Crystal Pit Division of IN( <br /> aerats <br />and Cealagy <br />ANNNERSARY DATE: March 26, 2004 <br />ANNUAL FEE DUE: $281.00 (Due on or before your a nniversary date) <br />COUNTY: Teller <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 />z 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'perforn-.ed-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 yner revised written annnal re~nrt and annual r„nnrt 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 <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Dave D. Jordan <br />Permittee Name: City of Colorado Springs <br />Address: P. O. Box 1575 <br />Mail Cade 060 <br />Colorado Springs, CO 80901-1575 <br />Phone Number: (719) 385-7715 <br />Fax Number: (719) 684-2234 <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 />Signature of Corporate Officer, Owner, or Designee <br />y/~/a ~i <br />Dat~'~ <br />M:~PERMITMASTERDOCUMEMSVN-AF-04 <br />