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+ ~' <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUN'T'Y: <br />~~; <br />RE~~lil ~® <br />MpY28~ <br />Division of Minerals and Geolo9Y <br />Morgan County <br />M-1978-162 <br />Harvey Green Pit <br />June 29, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Morgan <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 />-lan , rec amanon accomplished to date and during the preceding year, new disturbances that: are anticipated fo <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 ynnr rPViced written anneal report and annual rennrt m~tn 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: Joe B. Baltazar <br />Permittee Name: Morgan County <br />Address: 17303 CR S <br />Ft Morgan, CO 80701 <br />Phone Number: (970) 542-3560 <br />Fax Number: (970) 542-3569 <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 />ature of Corporate Office caner, or Designee <br />Date <br />M:IPERMI'I~MASTERDOCUMENTSNI-AF-04 <br />