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:,. ~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Fremont County <br />M-1984-117 <br />Fremont Gravel Pit <br />January 20, 2006 <br />REC~~~E®. <br />/ FEB 0 3 2006 <br />i <br />v Uiv~sian of Minerals and Ceofog y <br />$281.00 (Due on or before your auuiversary 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 />opeiator shall sulimit'the annual-fee,-a-report and map showing the eztent`of current 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 year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please Mach ym~r revised written annual re~nrt and annual rennrt main to 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. <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: 615 Macon Ave 100 <br />#105 <br />V ANNi1Ai. FF,F, and RF.Pt7RT RF.ni1F.ST <br />Canon City, CO 81212 <br />Phone Number: (303) 942-4234 <br />Fax Number: <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 />_~Si4~ // • ~~ <br />Signature of Corporate fficer, Owner, or Designee <br />~ / ~ <br />Dale <br />M:NERMITh]ASTERDOCUMENTSNI-AF-04 <br />