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t~ <br />RECEiV~® <br />ANNiiAI. FF,F, and RF.PnRT RF,OI1F.ST <br />NOV 2 0 2003 <br />PERMITTEE NAME: Montezuma County piuisi°n of Mi°e~als and Ga°ip0' <br />PERMIT NO.: M-1978-107 <br />OPERATION NAME: Tozer Pit <br />ANNIVERSARY DATE: November 2, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Montezuma <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />-_ .operator shall_submit_the_annual fee,_a_report_and_map showing_the_extent of current disturbances to affected _ __ <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach xpur revised written anm~al rennrt and anneal rennrt man to this form. Please note that an <br />adequate/y labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lloyd Everett <br />Permittee Name: Montezuma County <br />Address: 1680 Hwy. 145 <br />Cortez, CO 81321 <br />Phone Number: <br />565-8666 _ _ <br />Fax Number: (970) 565-8252 ~r <br />If you have additional comments and/or information that should be provided [o the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />~~~~o~ ~~ <br />$ignature/bf Corporate Officer, Owner, or Designee <br />1 O ~g/~~ <br />Date <br />M:\PERM ITUTASTEADOCUMENTSUA-AF-04 <br />~~ A_. <br />