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<br />PERMI'I'I'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Otero County (Engineering) <br />M-1981-279 <br />Hancock Gravel Pit <br />February 1, 2002 <br />RECEIVED <br />FE8 ~ 6 2902 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Otero <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 [he annual fee, a report and map showing [he 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 [he coming year, [he 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: Kenneth S. Parker <br />Permittee Name: Otero County (Engineering) <br />Address: P.O. Box 511 <br />La Junta, CO 81050 <br />Phone Number: (719) 383-3035 <br />Fax Number: (719) 383-3935 <br />If you have additional comments and/or information that should be provided [o the Division, please provide it <br />below or attach it [o this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />t <br />Signatu orporate Officer or O per <br />I~~/~- <br />Date <br />M:tPERM n V.IASTER DOCUMENTSNI-AF-01 <br />