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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Grand County <br />M-1977-256 <br />Benson Pit <br />March 23, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Grand <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 shalt 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 aze 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 man to this form. Please note that 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 petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: M C. Branstetter <br />Permittee Name: Grand County <br />Address: 467 E. Topaz Ave. <br />P.O. Box 9 <br />Gtanby, CO 80446 <br />Phone Number: (970) 887-2123 <br />Fax Number: (970) 887-3168 <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 f Corporate Officer, Owner, or Desigtee <br />aj~ la3 <br />Date <br />~ECEIVEp <br />FEB 0 7; 2QG3 <br />Division of Minerals and Geology <br />~~ <br />M:~PERMITMAS7ERD000MEMSVr1-AF-04 <br />