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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Prowers County <br />M-1977-387 <br />Bates Pit <br />December 1, 2002 <br />RECEIVED <br />NOV 1 g 2002 <br />division raf Minerals and GealogY <br />$688.00 (Due on or before your anniversary date) <br />Prowers <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 [he extent of current disturbances to affected <br />-`-land; rreclamation accomplished to date and during the preceding year, new disturbances [hat 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 petTnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tony Garcia <br />Permittee Name: Prowers County <br />Address: 109 E. Sherman St <br />Lamar, CO 81052 <br />__ Phone Number: _ _ (719) 537-6631 _ <br />Fax Number: (719) 537-6357 <br />If you have additional comments andfor 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 />i <br />Signature of Corporate Officer, caner, or Designee <br />Date <br />M:~PERMI7IMASTERDOC UMENTSVvI-AF-04 <br />