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~~ <br />N <br />RECEIVED <br />AUG 0 7 2004 <br />PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kerr & Son Trucking <br />M-1984-043 <br />Jesse Lee <br />July 25, 2004 <br />$225.00 (Due on or before your anniversary date) <br />Chaffee <br />Division of Mn~eroln & lieolapy <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 />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 yunr revised written annual r~nrt and annual re~{prt masn to this form- Please note that 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: Donald R. Ken <br />Permittee Name: Kerr & Son Trucking <br />Address: P.O. Box 1496 <br />Buena Vista, CO 81211 <br />Phone Number: (719) 395-2910 <br />Fax Number: <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 />~~~~ <br />Date <br />MiPERM1ILNAS7ERDOCUMENtS/M-AF-02.DOC <br />