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y~~ <br /> ANNiiAi. FF.F. and RF,PnRT RFO iiF.ST <br />~~~'~~ ~~~ <br />PERMITTEE NAME: Morgan County <br />PERMIT NO.: M-1985-200 DEC 9 5 2003 <br />OPERATION NAME: Kula Gravel PIt <br /> Giuision of Minerals and Geologg <br />ANNNERSARY DATE: December 18, 2003 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Morgan <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 your revised written annual renort and annual re rn rt man 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: Joe B. Baltazar <br />Permittee Name: Morgan County <br />Address: 17303 CR S <br />Fort Morgan, CO 80701 <br />Phone Number: (970) 542-3560 <br />Fax Number: (970) 542-3569 <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 />gnature of Corporate Officer, Ow r, or Designee <br />~~-~a-o3 <br />Date <br />M:~PERMITVNASTERD000M ENTSVM-AF-04 <br />