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,~ f <br />~~ <br />PERMITTEE NAME: <br />PERMTI' NO.: <br />OPERATION NAME: <br />~~YV 6 <br />Delta County <br />M-1978-172 <br />Antelope Hill Pit <br />V <br />Rf CEI VED <br />NOV 0 5 Z~~4 <br />ANNNERSARY DATE: October 26, 2004 Division ~f Minerals and Geology <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Delta <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of cun•ent 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 yeaz, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach y9nr revised written annul re,Pnrt and annnal report man fn this form- please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. ,q~~ ~~j4 <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Larry Record <br />Delta County <br />501 Palmer St., Ste. 227 <br />Delta, CO 81416 <br />(970)874-2100 <br />(970)874-2114 <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 Corporate Off er, Owner, or Designee <br />Date <br />M:~PERMI7IMASTERDOCUMENTSNI-AF-04 <br />