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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Washington County <br />M-1988-032 <br />Fassler Gravel Pit <br />May 18, 2002 <br />~ ICJ <br />RECESSED <br />APR 2 51a02 <br />Division of Minerals and Ceolo9Y <br />$281.00 (Due on or before your anniversary date) <br />Washington <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 oof wrtent distuibances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances [hat are anticipated [o <br />occur during the upcoming year, reclamation [hat 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 mau 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 informatidn. Please verify and make any necessazy <br />changes: ~~ <br />Permittee Contact: Y'• ~ // {vI ~ ~sE if tf <br />Permittee Name: Washington County ~g,~ h;nS ~~ Crst,~,~,~ti <br />Address: 150 Ash St. /SL7 >`?s 6rt .n7 f. <br />~ IG r'tsNt ~ L7 <br />Akron, CO 80720 ~'b7d d <br />Phone Number: (970) 345-2701 <br />Fax Number: (970) 345-2702 <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 />~Lva~C-- <br />ignature of Corporate Officer or Owner <br />~~a3-oa <br />Date <br />M:tPERMITMASTERDOCUMENTSU4-AF-04 <br />