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RECEIVED <br />ANNUAL FEE and REPORT REQUEST <br />NOV 0 7 2002 <br />Division of Minerals and Geology <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Elbert County <br />M-2001-056 <br />Belveal Gravel Pit <br />November 9, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Elbert <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 your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled nwp that clearly delineates and includes the above elements may since 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: Tim Sheridan <br />Permittee Name: Elbert County <br />Address <br />Phone Number: <br />809 Ute Ave <br />Simla, CO 80835 <br />(719)541-2268 <br />Fax Number: (719) 541-2826 <br />If you have additional comments and/or information that should be provided ro 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 />Sijgn~ature of Q r to O icer, Owner, or Designee <br />l~ c~ ~15~ ~aZ <br />Date <br />M:NERMIT~AIASTERDOCUMENTSUI-AF-Q1 <br />