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a <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />Fremont County <br />M-2001-087 <br />Indian Springs Park Pit <br />February Il, 2003 <br />FiECE1 VED <br />JAN 3 02003 <br />Division at Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Fremont <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 during the preceding year, new disturbances that are 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 annual rennrt and anneal r~nort mad to [his form. Please note That an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee coniactinformation. Please verify and make any necessary <br />changes: <br />Permittee Contact: C I• <br />Permittee Name: Fremont-Eounty <br />Address: 6I'S-1vI c~tt~ve. <br />PAUL GARRETT <br />FREMONT COUNTY <br />615 MACON AVE., ROOM 411 <br />C~tTOn-City-EO-8~1-2-1~ <br />Phone Number: (719}x--1-51.5 <br />CANON CITY, COLORADO 81212 <br />{719) 942-4234 <br />Fax Number: (7}912?5?626 <br />(719) 276-7321 <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. <br />Signature of Corporate Officer, Owner, or Designee <br />-~ ~~ 2.2 - C~ J <br />Date <br />MaPERMITNrASTER DOCUMENTSNI-AF-04 <br />