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<br /> <br />PERMIT"I'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Donald R Hart <br />M-1980-049 <br />Mott Gravel Pit <br />February 18, 2004 <br />$281.00 (Due on or before your anniversary date) <br />Montrose <br /> <br />fE8 2 ~ 20~ <br />Dieisisn of Minerals & GeolopY <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 operator <br />shall-submit the--annual fee, areport-and-map-shaving th;,-extent of-current dis[urbanccs to affected -land,- - - <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be perfonned during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please aftachynnr revised written annnal re,~rt and annnal re~nrf mar fn this fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Donald R. Hart <br />Permittee Name: Donald R Hart <br />Address: 3500 Clear Fork Rd. <br />Crawford, CO 81415 <br />Phone Number: (970) 921-5299 <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 enclosed. <br />M:~PERMITMASrERDOCUMENT5IM-AF-01 <br />