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..•• <br />ANNUAL REPORT <br />PERMITTEE NAME: Prowers County <br />PERMTI' NO.: M-84-134 <br />OPERATION NAME: Randy Shaw Pit <br />ANNNERSARY DATE: August 31, 1999 <br />ANNUAL FEE DUE ON ANNIVI'sRSARY DATE: $225.00 <br />COUNTY: Prowers <br />According to C.R.S. 34-32-116(3)(a), each yeaz, on the anniversary date of the pe it, an <br />operator shall submit the annual fee. a report and map showing the extent of curre t disturbances <br />to affected land, reclamation accomplished to date and during the preceding year, ew <br />disturbances that aze anticipated to occur during the upcoming year, reclamation t a[ will be <br />performed during the coming year, the dates for the beginning of active operations and the date <br />active operations ceased for the year, if any. <br />ennu8l report. Please note that an adequnte[y labeled mnp that clearly delrneakes and <br />includes the above elements may sake for a written report. <br />Please type or print the curtent contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: Company: <br />Address: Phone No.: <br />Fax No.: <br />If there are additional comments and/or information that should be provided to the~ivision, <br />please provide it on a separate sheet and attach it to this report form along with yo r map and/or <br />written report. <br />Signature of Corporate Officer, or Owner <br />Date <br />/N,STRUCTIONS ON BACK <br />