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<br />RECEIVED <br />APR 2 4 2003 <br />Division ~f Minerals and Geology <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Washington County <br />M-2001-012 <br />Shook Gravel Pit 1 <br />May 31, 2003 <br />$688.00 (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 />op8rdtor shall"su~it`fhe annual fee, a re- port and-map s owing t e extent o current tstur ances to a ected <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 wilt be performed during the coming year, the dates for the <br />lleginning of active operations, and the date active operations ceased For the year, if any. <br />Please attach y~nr revised written anneal rennrt and annaal report m T to this fnrm_ 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: Charles J. Kuntz <br />Permittee Name: Washington County <br />Address: 150 Ash St. <br />Alvon, CO 80720 <br />Phone Number: (970) 345-2701 <br />Fax Number: (970) 345-2702 <br />~' <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. Annuat Report instructions are <br />enclosed. <br />l/W~IY.ta/ ~ ~7.tmK/ <br />Signature of Corp ate Offic ,Owner, or Designee <br />Date <br />M:NERMITMASTERD000MENTSUA-AF-04 <br />