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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Fremont County <br />M-1990-047 <br />Quargmire Creek <br />January 20, 2003 <br /> <br />O~~i, ~~~~sio a <br />.3? <br />d~ECEB!/I~® <br />JAN 151003 <br />Dtvtsion o(Minerals and Geology <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <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 [he date active operations ceased for the year, if any. <br />Please attach ynnr revised written annual renort and annual report m„ am to Chic form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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 Garrett <br />Permittee Name: Fremont County <br />Address: Fremont County Cortunissioners <br />615 Macon Ave., Room #105 <br />Canon City, CO 81212 <br />Phone Number: (719) 276-7320 <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 ~ Corporate Officer, Owner, or Designee <br />~,-~,-~~ <br />Dale <br />MaPERMITMASTEROOCUMENTShl1-AF-04 <br />