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~ ~ ~P~°% <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Holyoke Gun Club <br />-1977-075 <br />Holyoke Gun Club Pit <br />September 27, 2005 <br /> <br />RECEIVED <br />SEP 2 3 2005 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Phillips <br /> <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 />steal-3-cuTmit_Yhe-.annual=fPe-a'report=znd=map-showirg-the' estert-of cun'ert-disturbances ie- of acted :arid, _ <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 performed 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 attarh vnnr revised written annual report 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 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: Gary Hershfeldt <br />Permittee Name: Holyoke Gun Club <br />Address: 20358 CR 45 <br />Holyoke, CO 80734-9507 <br />Phone Nnmher• ~9ZQ)_$54_3641 _ _ _ ____ __ _ _ _ _ <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 />Signature of Corporate Officer, Owner, or Designee <br />~- as -o~ <br />Date <br />