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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />\~o hh P <br />DG Huslcin Construction Company <br />M-2002-118 <br />Velarde Pit <br />June 9, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Huerfano <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 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 attach your revised written annual re~nrt and annual report mad 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 pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Richard L. Pounds <br />Permittee Name: DG Huskin Construction Company <br />Address; P.O. Box 61 <br />Westmore, CO 81253 <br />Phone Number: (719) 784-0415 <br />Fax Number: (719) 546-2143 <br />~t,~~,ur~ ~ P~ ~io~.<.~'h~ r <br />P.U, P~~~ ~~~ <br />Q~~ ~~~ C~o lar a~ c~ ~s ~ i~t~ <br />? l~r' ~-7 Z' C^c °I -7 of <br />.~1~ ~~_ v ~ i~ LI7 <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 />\7'~ ~ `~~ <br />Date .. <br />