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I ~- <br />RECEIVED <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 />Geroux Gravel <br />M-2000-059 <br />Geroux Gravel <br />February 22,2002 <br />FEB ~i 9 2(Ui2 <br />Diritloo of Minerals and 6eelogy <br />$281.00 (Due on or before your anniversary date) <br />Custer <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and luring the-prec:dilig yea., new disturbances-that are anticipated do occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Darrell Geroux <br />Permittee Name: Geroux Gravel <br />Address: 1100 CR 160 <br />Westcliffe, CO 81252 <br />Phone Number: (719) 783-2709 <br />Fax Number. (779) 753-2709 <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 enclosed. <br />_16,Gc'n~ <br />Signature of Corporate Officer or caner <br />'~/G 0,2 <br />Dale <br />M:~PERM ITUTASTERDOCUMENTSU1-AF-01 <br />