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999 <br /> ANNUAL FEE and REPORT REQUEST <br /> RECEIVED <br /> PERMITTEE NAME: Delta County <br /> PERMIT NO.: M-1978-172 OCT 2 9 2001 <br /> OPERATION NAME: Antelope Hill Pit Division of Minerals and Geology <br /> ANNIVERSARY DATE: October 26,2001 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUN'rY: Delta <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 /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur curing 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 your revised written annual report and annual report map 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 /> Divisicn records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: / <br /> Permittee Contact: A414fGbr1:/ <br /> Permiuee Name: Delta County <br /> Address: 501 Palmer St., Ste. 227 <br /> Delta, CO 81416 <br /> Phone Number: (970) 874-2100 <br /> Fax Number: (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 /> f� 1 <br /> Signature of rporate Officer or Owner <br /> /(.D -- -�� <br /> Date <br /> MAPERMI RMASTERDOCUMENTSW-AF-04 <br />