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<br /> <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Rio Blanco County <br />PERMIT NO.: lbt-1995-046 <br />OPERATION NAME: Johnson Draw <br />FiECEtVED <br />OCT 17 2002 <br />ANNIVERSARY DATE: October 7, 2002 Oivisian of Minerals and Geology <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <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 <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may s~ce for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jerry Steele <br />Permittee Name: Rio Blanco County <br />Address: 570 2nd St. <br />Meeker, CO 81641 <br />F970}878-5601-~~--°°__-~- _=- -- - - - -- - - <br />Fax Number: (970) 878-3396 <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 <br />enclosed. <br />Signat of Corpora Officer, Owner, or Designee <br />®G~eber :2, r'J2 <br />Date <br />M?PERMITUI ASTERDOCU MEMSNI-AF-04 <br />