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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 />Hardrock Sand and (.ravel <br />M-1990-140 <br />Martin Pit 1-A <br />December 18, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Moffat <br />RECEIVED <br />FEB t 9 20D3 <br />Division of Minerals and Geology <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 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-during-the preceding-year,-new-disturbances-that-are-antieipated-to-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 vour revised written annual report and annual resort 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: Pat J. Weber <br />Permittee Name: Hardrock Sand and Gravel <br />Address: P.O. Box 141 <br />Craig, CO 81626 <br />Phone Number: (~9j-8-2#hB53-"~ ~7U~ ~~^ ~GS~ <br />_ Fax-1~Iumber: - --- - - --- - - - - ~~/LJ~ - - ---- <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 />,_ _ <br />Si ture of Cotpor a Officer, Owner, or Designee <br />-/ 7-O <br />Date <br />/~~r~ <br />sp~i~:~ O G o?a°~ <br />M: WERMITIMASTERDOCUMENTSIM-AF-01 <br />