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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Ouray County <br />M-1978-268 <br />Dallas Gravel Pit <br />March 22, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Ouray <br /> <br />'ivision at i;iinerzls & ~^*ir^ <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-am~ttal-fee,-a-report-and map showingxhe extent-o£currenLdisturbances_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 ynnr revised written annual rennrt and anmral rQ,pnrt maw to Chic form- Please note that au <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: Bob Wolford <br />Permittee Name: Ouray County <br />Address: P.O. Box 456 <br /> Ridgway, CO 81432 <br />Phone Number: (970) 626-5391 <br />Fax Number: (970) 626-4439 <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 />=`=~7T~ IN <br />Signature of Corporate facer, Owner, or Designee <br />.~/~~ <br />Dates <br />M:U'ERMITNIASTERDOCUMENTS~M-AF-04 <br />