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~Yy~ ~ <br />• ' <br />V <br />RECEIVED <br />APR 2 4 2003 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Washington County <br />M-1983-001 <br />Cecil 11-34-49 <br />May 16, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Washington <br />Oirision ~f Minerals and Geology <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 />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 attach ynnr revised written anneal re~nrt and annual re~nrt 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 /> <br />Permittee Contact: Larry Champ <br />Permittee Name: Washington County <br />Address: 150 Ash <br /> Akron, CO 80720 <br />Phone Number: (970) 345-2701 <br />Fax Number: (970) 345-2702 <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 />' azure- f Co o ate Officer, weer, or Designee <br />y-/~F-~3 <br />Date <br />M: W ERMITMASTERDOCUMENTSV.1-AF-04 <br />