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iiiiiiiiiiiiiiiiiii. ® ~ <br />Ar;~...,._..999 <br />PERMITTEE NAME: Bent County ~~CEIVED <br />PERMIT NO.: M-92-113 <br />NOV 12 1999 <br />OPERATION NAME: Verhoeff Pit No 2 O~lpgy <br />n ct Murerab & <br />ANNNERSARY DATE: December 17, 1999 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $550.00 <br />COUNTY: Bent <br />According to C.R.S. 34-32.5-116(3)(a), each year, on the anniversary date of the permit, an operator <br />shall submiuhe 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 <br />anticipated to occur during the upcoming year, reclamation that will be performed during the coming <br />year, the dates for the beginning of active operations, and the date active operations ceased for the year, <br />if any. <br />Please attach your revised annual report map and written report to this annual report. P/ease <br />note thnt nn adequately ln6eled map that clearly delineates and includes the above elements may <br />suffice for a written: report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: Virley Burkhalter Company: BENT COUNTY <br />Adddress: p.o. BOX 350 PhoneNo.:(7tg) 456-2223 <br />LAS ANIMAS, CO. 81054 Fax No.:(719) 456-0375 <br />ff there are additional comments and/or information that should be provided to the Division, please <br />provide it on a sepazate sheet and attach it to this report form along with your map and/or written <br />report. <br />~~ , ~../. ~~ .GID~ 10 / 29 f 99 <br />Signature Corporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />