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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Harold Brandstadt <br />M-1986-004 <br />Brandstadt Rock Pit <br />January 24, 2004 <br />JAN' 2 200¢ <br />Oiyisian olMinerals and Geolo9Y <br />$281.00 (Due on or before your anniversary date) <br />Delta . <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 />shall submit the annual Fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation-accomplislacd-to-date-and-during-the-preceding-year, new-disturbances-that-are anticipated to-eecur- <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 far the year, if any. <br />Please attach ynnr revised written annual rennrt and annual rennrt p1,1p to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Harold Brandstadt <br />Permittee Name: Harold Brandstadt <br />Address: -3040-GRd- / <br />Delta, CO 81416 <br />Phone Number: (970) 874-4159 <br />Fax Number: <br />tl~a~ra''Id~t- / l3ra>~77ds7`ad~' <br />cL-'=1---rf /n ~J Y ~ <br /> <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 />Q o-,n <br />Date '~' <br />M:~PERMIi1MASTERD000MENTSUI-AF-01 <br />