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~, <br />ANNIiAi, FF.F. and RF.PiIRT RF.( i~iFST <br />•.1 <br />PERMITTEE NAME: Rio Blanco County i : ~ I G,.J <br />PERMIT NO.: M-1977-136 <br />,,.; , „~m•~• <br />OPERATION NAME: Prather Pit <br />ANNNERSARY DATE: February 23, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <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 />--- --lar!ct; rsclamationaccomplished-to-date-and-clearing-the-preceding_year,-nexudisiushances_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 ym~r revised written anneal re~nn and anneal rennrt mT to this form. Please note that an <br />adequately [abeded map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Jew3~Steele <br />~LL~I ~ c, ~? YVl o r ~ n <br />Permittee Name: <br />Address <br />Rio Blanco County <br />570 2nd St. <br />Meeker, CO 81641 <br />Phone Number: (970) 878-5601 <br />Fax Number: (970) 878-3396 <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 />gnature f Corpora O~ cer, Owner, or Designee <br />~/ s/d~'~ <br />Dat- a -r <br />M:IPERM7'I~MASTERDOCUMENTSUI-AF-04 <br />