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~" <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Morgan County REC+E9VED <br />PERMIT NO.; M-1979-210 ~AY Q r <br />OPERATION NAME: Vancil Pit <br /> Oiuision of MinerelsgRO C <br /> <br />ANNIVERSARY DATE: <br />May 4, 2002 eolegy <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Morgan <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 vour 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 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: Joe B. Baltazar <br />Permittee Name: Morgan County <br />Address: 17303 CR S <br />Ft Morgan, CO 80701 <br />Phone Number: (970) 867-9446 <br />Fax Number: (970) 867-5264 <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 />~~ <br />ignature of Corporate Offi or Owner <br />ay dz <br />Date <br />M:~PERM77V~1ASTERD000MENTSVN-AF-04 <br />