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ti ~= <br />t <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Dewitt Excavating <br />M-1983-132 <br />Dewitt Excavating <br />July 29, 2002 <br />RECEIVED <br />JUL 2 ~ 2002 <br />Division of Minerals and f>eolo9Y <br />$281.00 (Due on or before your anniversary date) <br />Prowers <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 />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, [he dates for [he beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report maa 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: Terry <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />7395 U.S. <br />Lamar, CO 81052 <br />(719)336-4455 <br />(719)336-8150 <br />~eWl',t-+ ~ ~~ <br />~` D~W~ k{- ~xeaya+i n- ~ n~ <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 />Sign ure of Corporate Officer or Owner <br />Date <br />M:~PERM171MASTERD000MENTSUv7-AEA I <br />