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~~--- <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Richard Fryrear <br />M-1995-071 <br />Fryrear Gravel Pit <br />November 6, 2002 <br />RECEIVED <br />OCT 182002 <br />Division of Minort,(; ;,r] g, ~, 2P <br />$281.00 (Due on or before your anniversary date) <br />Yuma <br />According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, 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_Xear,-nary disturbances that_are_anticipated_to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginniaa <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 map to this 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: Richard Fryrear <br />Permittee Name: Richard Fryrear <br />Address: 8085 CR 13 <br /> Haxtun, CO 80731 <br />Phone Number: (970) 774-6551 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide i[ <br />below or a~h it to this form along with your written report and map. Annual Report instructions are enclosed. <br />of <br />Owner, or Designee <br />io/~/~. <br />Date <br />M:IPERMITU4ASTERDOC UMENTSVvI-AF-01 <br />