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<br />~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Cross Mountain Ranch Ltd. Partnership <br />M-1979-102 <br />Kagie Gravel Pit <br />June 21, 2004 <br /> <br />FtECEIVE® <br />JUN 0 2004 <br />Division of Minerals and Ceofogy <br />$281.00 (Due on or before your anniversary date) <br />Routt <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, a report and map showing the extent of current disturbances to affected land, <br />are anncroatea 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 attach ymrr revised written annnal rennrt and annnal re nn rt map to Chic 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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Kathy Hockin ~U h ~ 1-1.4f ~'i'Y1 u Y' <br />Cross Mountain Ranch Ltd. Partnership <br />P.o. Bax 1029 18'1 B 13`~ ~~. <br />Hayden, CO 81639 c>~1-CQi1M~Vj ydsl ~J[~ ~ O~y 0 7 <br />(970) 276-3718 _ ~7©~ `~ 7 ~- ~c 2 3 <br />X970>276-371a ~~7a~ ~`jq -(oZ~~S <br />If you have additional comments and/or infomtation 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 />9-~ <br />Signature c Corporate Of tcer, Owner, or Designee <br />Date <br />