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'~~ ~ III IIIllllllllll III <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTP.E NAME: Fremont County <br />PERMIT NO.: M-1989.084 <br />OPERATICIN NAME: Oak Creek Gravel Pit <br /> <br />RECEIVED <br />JAN 1 41001 <br />ANNNER'iARY DATE: January 20, 2002 Division of Minerals and GeoloAY <br />ANNUAL I~EE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning cf active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note rltat an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: .IL,e <br />Permittee !`lame: Fremont County <br />Address: .$.9--IS'~ <br />Phone Number: (~W}.94~2~8 <br />Fax Number: <br />`~~ J. <br />~l~- ?-~~ • ~3Z~ <br />-~~ • z~~~ ~~zb <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 />12 t~~ol <br />Date <br />M:~PERM RVNA~ TERDOCUMEI.TSNI-AF-Oi <br />