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_r~ <br />- .~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Orlando & Rose Marie Martinez <br />M-1985-008 <br />Leone-Gardner Gravel <br />March 22, 2002 <br />RECEt VED <br />MAR 10 1001 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Huerfano <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />' - eeclati,aiiou accowplished to date and-during-thc ptcceding-year, new disturbances-than are anticipated-to -occur ' -- <br />during the upcoming year, reclamation that will be performed during [he coming year, [he dates for the beginning <br />of active operations, and [he date active operations ceased for the year, if any. <br />Please attach your revised written annual reuort and annual report maa to this form. Please note that an <br />adequately labeled neap that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following Permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: CF.PR.contact first name CF.PR.contact last name <br />Permittee Name <br />Orlando & Rose Marie Martinez <br />Address: 1 Kiowa <br />Phone Number: <br />Pueblo, CO 81006 <br />(7l9) 544-3237 <br />c.,~ rr, tie~• t710~ c6~ mzr <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 enclosed. <br />bC <br />tgnature of Corporate Officer or Owner <br />Date <br />M:~PERMITVviASTERDOCUMENTSNI-AF-OI <br />