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:, <br />RE~~~~~~ <br />~rJN O6e1~a~aGeo\o~INNUAL FEE and REPORT REQUEST <br />ot~ <br />PERMITT~'RFAME: Yuma County <br />PERMIT NO.: M-1981-256 <br />OPERATION NAME: Ekberg Pit <br />ANNIVERSARY DATE: June 30, 2002 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Yuma <br />MAMY 0 2 2002 <br />1~ <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-annual fee, a regor[ and map showing-the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances [hat 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 vour revised written annual reuort and annual reuort mao to this 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: Paul Like <br />Permittee Name: Yuma County <br />Address: 1310 S. Blake St. <br />Phone Number: <br />Fax Number: <br />Wray, CO 80758 <br />(970)332-5718 <br />(970)332-3429 <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 />~~ ~~ <br />Signature of Corporate Officer or Owner <br />S" -/ ~ -O ~ <br />Dale <br />MIPERM17wIASTERD000MENTSNI-AF-Da <br />