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Y <br />PERMITI'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />_ COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Crowley County <br />M-1982-126 <br />Crowley Cnty Grav 2 <br />Apri128, 2002 <br />$688.00 (Due on or before your anniversary date) <br />RECEIVED <br />MAR 1 1 2A02 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on [he 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 />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 vour 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 <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Deana Harris MIKE APKER <br />Permittee Name: Crowley County <br />Address: 603 Main St. Ste. 2 <br />Ordway, CO 81063 <br />Phone Number: (719)267-3248 719)257-5555 ext!2 <br />Fax Number: (719) 267-3114 <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 />- -- ------~%=-F-Aa - -------- ---__------- --- <br />Sign re of Corporate Officer or Owner <br />3 •5 -oz, <br />Date <br />M:IPERMI'IlA7A5TERD000MENT5IM-AF-04 <br />