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r <br />~~= '°` ~~ <br />RECEIVEp <br />JAN 1 3 2006 <br />era geology !i <br />PERMITTEE NAME: Forest Lakes Metro District v <br />PERMIT NO.: M-1981-158 / <br />OPERATION NAME: Forest Lakes Pit #1 <br />ANNIVERSARY DATE: January 26, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />- - - - _ operator shall'submit [he annual'fee,'a repott-and-map showing [he extent of current distuebances 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 vrnur revised written annual re¢nrt and annnal re~nrt m ~n 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: Dale Kortz <br />Permittee Name: Forest Lakes Metro District <br />Address: P.O. Box 440 <br />Bayfield, CO 81122-0440 <br />Phone Number: (970) 884-2925 <br />Fax Number: (970) 884-0305 <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 />M;IPERMINIASTERDOCUMENTSU-f-AF-04 <br />