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. :, <br />.. <br />`" ~6~~- <br />REG~'r ~ 9~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~. ANNTIAi, FF.F, and REPORT RF.QTIF.ST <br />;,~ Fremont County <br />d M-1979-216 <br />Dist No 2 Gravel Pit <br />January 20, 2006 <br />" FEB ~ ' z~u& <br />vision of tdmi~ ~,~ ~„; ecology <br />$281.00 (Due on or before your anniversary date) <br />Fremont <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 I <br />operator shall submif'the annual-fee,-a'report and-map showing-the exrtenY`of currenCdis[urbances"t-o affect"ed <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 mnr revised written annnat rr,~nrt and annual re~nrt myyt to thin form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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 Terry Acton <br />Permittee Name; Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room #105 <br />Canon City, CO 81212 <br />Phone Number: (719) 784-6474 <br />Fax Number: (719) 275-7626 <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 />enclosed. <br />Signature of Corporal fficer, Owner, or Designee <br />Date <br />M:IPERM771MASTERDOCUMEMSIM-AF-04 <br />