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-~ - 6 15:28 FROM-Colorado Divis'an of Yirerala 8 Oeolosy +1303832810fi T-414 P-083/003 F-861 <br />~hP <br />REC~~~.-'~~~~ <br />P"RMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />Arnvrv~RSARYnATE: <br />ANl1UAl. FEI: IaUE: <br />calmry: <br />D.G. Elusloa Cottstrattion Olt11p81Q' <br />M-xooazzs <br />PJno Pid <br />Novtm-tr 1S, zoos <br />JAN 1 l 2006 <br />Division of Minerals and Geology <br />5688.00 (Due on or bd'ore yoer aauiversary daft) <br />antra:t <br />According to C.RS_ 34.32.5-216 or C.R.S. 34.32.116, tack pear, oa the armivcrsary dots of tht permit, an operator <br />shalt submit the annual fee, a report and map showing lire extrnt of currtttt disturbances to atfected lend, <br />o reclamation accomplished to date and during the preceding year, raw dis:urbarreas that ere atrtieipated to occur <br />° dutirtl; tits apcotuing year, reclamadan teat will be prrformai during the corning year, the dates for the begirming <br />olactive oporatioas, and the date active operations ceased far the yetr, if any . <br />0 <br />w <br />~ 1?leasp aHwch rant revised written annual rnvnrl and anneal rennri m ~° to 11r.;,e Cnrm P1EaSl Holt: llatr On <br />o - adegrtarely labeled map tkal clearly dc-irreares arrd frrclrldes /be abavs eleme~rls may-s+r~ieefor a t-niaen report <br />N <br />Division records indicate the following permittte comet information. Fleast verity and rnalut any accessary <br />changes: <br />Permittee Contact; Ric.~atd L. Potmdt <br />PermitteeName: _ arty <br />Addrtss: <br />aL - <br />W <br />F <br />o Phone Number: <br />' `~ Fax Number: <br />M1 <br /> <br />V~esdmore; EO 8345`-'1* <br />(7l9) 784.0415 <br />(7l4) 546-2143 <br />tn. c( <br />l4-IIP(( /~ S bu l'1ff tr u,~, 1'r).( 7C1'~ra' fte~ 7ta <br />L"1~(~/V ~tJ ~~~i~ c <br />n <br />rjI`•l- 3 iZ - ~`=1`7~ <br />7f you havro additional corrurrents and/or information that should be provided to the I?ivision, please provide it <br />'below or attach it to this form along with your written report and reap. Anaasl Repot[ instructions are enclosed. <br />w~ <br />l Sign oP Corpm/ate 031ica, Owner, or Designee <br />~ Drat------l~f ~'.F!% ~-- <br />v <br />~_ <br />V <br />U <br />V <br />