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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rio Grande County <br />M-1987-019 <br />South Fork Pit <br />March 25, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Rio Grande <br />j~ <br />1 CJ <br />RECEIVED <br />MAR 2 2 2002 <br />Division of Minerals end Geology <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 />- - -]and; reclamation aceornplished to date-ard during-the preceding pear, netiv-dismrbanee~ that-are anticipatcd-tc -- <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for [he <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual resort map to this form. Please note than an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following perrnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lawrence "Buddy" Shaver <br />Permittee Name: <br />Address <br />Rio Grande County <br />168 N. Washington <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-4781 <br />Fax Number: (7l9) 852-0305 <br />If you have additional comments and/or information [hat 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 />Signature of Corporate Officer or Owner <br />l r--D"Z_ <br />Date <br />M dPERMITNIASTERDOCU MENTSVd-AF-di <br />