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:- <br /> <br />r4~.~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Montezuma County <br />M-1999-077 <br />Ormiston Gravel Pit <br />October 25, 2004 <br />,~ <br />OCT i t~ ZG04 <br />Division ai ~'.+ :ur .. ~ Gsnlc~i~ <br />$688.00 (Due on or before your anniversary date) <br />Dolores <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 dwing tln;preceding year,-new-disturbances that aze 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 annnal re~tnrt and annual report map to this form. Please note that an <br />adequately labeled map [hat 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: Lloyd Everett <br />Permittee Name: Montezuma County <br />Address: 1680 Hwy. 145 <br />Phone Number: <br />Fax Number: <br />Cortez, CO 81321 <br />(970)565-8666 <br />(970)565-8252 <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. qq ~~ <br />1V~D 1~2u~ /~G;~dv~ -~~ <br />_ C~~ l 0/03 i a ~,~ <br />~gnature f Corporate Officer, Owner, or Designee <br />/~ ~ ~ ~D ~/ <br />Da~- <br />M:~PERMr11MA5TERDOCUMENTSM-AF-04 <br />