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<br />RECE°`-'~C <br />MAR 0 2 2004 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Gillette Sand and Gravel, Inc. <br />M-1992-009 <br />Gillette Pit <br />February 9, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Teller <br />Division of Mi~ <br />_ According to C_R.S. 34-32.5-116 or C _12,5. 34-32_116,.each year, on the anniv_er_sary_date of the permit, an operator __ _ <br />shall submit"the annual-fee,,-a-report-and-map-shawing_the_extent_of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ymlr revised written annnal rennrt and annnal rennrt m ~n to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: ~ /,, <br />Permittee Contact: Mark V. Yevoli ~~ /G ~~ "/ <br />Permittee Name: Gillette Sand and Gravel, Inc. <br />Address: 10002 Astoria Court <br />La/ne//Tree, CO 80124 <br />,LB-.tip ~rP~ ~ ~U/2~ y <br />Phone Number: (30_3) 799-6589 <br />Fax Number: (303) 799-6719 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attar it tot ' o along with your written report and map. Annual Report instructions are enclosed. <br />Si afore of Co drateb7fficer, O/\/1wn/er, or Designee <br />~JC/V <br />Date ~~ <br />M:~PERMIT~MASTERD000MENT54M-AF-01 <br />