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Og- X31.43/`f,2. ~S/ 00 <br />V <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Fremont County <br />M-1979-216 <br />Dist No 2 Gravel Pit <br />January 20, 2004 <br />RECEIVED <br />'JAN 212004 <br />Division of Minerals $~ Y <br />$281.00 (Due on or before your anniversary date) <br />Fremont <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 fir revised written annnal re~nrt and annnal report man 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: Terry Acton <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room # 105 <br />Canon City, CO 81212 <br />Phone Number: 7(_ 19) 276-7320 _ l q g~7 7 7"' <br />Fax Number: (719) 275-7626 <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 />c <br />S' nature of Corporate fficer, Owner, or Designee <br />Date <br />-/.?-o <br />M:~PERMIThIASTERD000M ENTSU-0-A F-OQ <br />