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~~ <br />~ III IIIIIIIIIIIII III ~ <br />999 <br />ANNUAL REPORT <br />PERMTI'TEE NAME: Kit (;arson County <br />PERMIT NO.: M-82-094 <br />OPERATION NAME: Kit Carson County* <br />ANNNERSARY DATE: June 24, 1999 <br />aye <br />Y <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Kit Carson <br />According to C.R.S. 34-32-1 16(3)(a), each year, on the anniversazy date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that aze anticipated [o occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and [he date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />antlual report. please »ote that an adequately tabelect trtap that clearly clelirtea(es curt! <br />inchtdes the above elenrents nary suffice for a wriden report. <br />Please type or print the current contact per'son's name, mailing address, and phone number in the <br />space provided: <br />Contact Nppame: <br />Address: Lry~(~X' J <br />t <br />~Q~ <br />Company: <br />Phone No.: ( t`i'(~[) 3410- c~„~ <br />Fax No.:~~a~~°~ t~c~~ <br />.~ <br />i <br />If there are additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />~~~LI <br />Signature of Corporate Officer, or Owner <br />:r =~i9 <br />Date <br />INSTRUCTIONS ON BACK <br />.~..._ ~ i __ ,.,..r1t _.,. .....-..,. <br />