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~. <br />Fremont County <br />M-2001-087 <br />Indian Springs Park Pit <br />February 11, 2004 <br /> <br />PERMTTTEE NAME: <br />PERMff NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />o~: ~. <br />RECEIVED <br />JAW 21 ?004 <br />Dlvbion of Minerals & GeoloBY <br />$688.00 (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--' f rl a annual fee, a report`and-map showing the-extent-ofcurrent-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 ymir revised written anmial rennrt and annnal red nrt man to thic 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: Paul Garrett <br />Permittee Name: Fremont County <br />Address: 615 Macon Ave., Room 105 <br />Canon City, CO 81212 <br />Phone Number: (719) 942-4232 <br />Fax Number: (719) 276-7321 <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 />_t,.~ <br />Si ature of Corporate ffic r, Owner, or Designee <br />Date <br />M:WERMI'i\MASTERDOCUMENTSUI-AF-09 <br />