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:o <br /> <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bent County <br />M-2001-019 <br />Bent County Pit # 2 <br />June 22, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Bent <br />JUN 0 2 2003 <br />Division ~t Minerals and 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 />_---land; rec[amatiori accomplished-to date-and durir[g the preceding yea% new disturbances that are an[icipaied 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 ymrr revised written annnal rennrt and annual rr nn rt maw 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: Gary L. Pritchard <br />Permittee Name: Bent County <br />Address: P.O. Box 350 <br /> Las Animas, CO 81054 <br />____.__Phone lltunber:_ (.719)_456.2223 <br />Fax Number: (719) 456-0375 <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 />~ Signature.of Corporate rcer~wner, or Designee <br />Dat~ <br />M:\PERM ITU1ASTE R DOC UM ENTSVv7-AF-04 <br />