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ANNIIAI. FF.F, and RFPnRT RF.(lI1F.ST <br />RECEIi/E~ <br />PERMITTEE NAME: Daniel M Russell <br />PERMIT NO.: M-1995-034 SEP Q 2 2004 <br />OPERATION NAME: Bachus Pit pivision of Mil,_:al: & peolo®y <br />ANNIVERSARY DATE: July 10, 20p~}- <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Alamosa <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 />reclaration accomplished to date and during [he preceding year, new disturbances that are anticipated 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 />Pieacc attach ym~r rcviced written anm~al report and anneal report man to thic f~rm_ 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 infortnation. Please verify and make any necessary <br />changes: <br />Permittee Contact: Daniel M. Russell <br />Permittee Name: Daniel M Russell <br />Address: 9042 S. 106 Rd. <br /> Alamosa, CO 81101 <br />Phone Number: (719) 589-3004 <br />Fax Number: (719) 589-3712 <br />If you have additional comments and/or infortrtation that should be provided to the Division, please provide it <br />below or attach it to this form along with yotu written report and map. Annual Report instructions are enclosed. <br />Signature of(Corporate officer, Owner, or Designee <br />Q-3l_p~! <br />Date <br />M;~PERM ITMASTERDOCUMENTSUI-AF-0I <br />