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<br />A <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />V <br />ATVNiiAi. FF.F, and REPORT RF.OiIF.ST <br />``Nick H. Gray <br />/m-2003-092 <br />Gray Pit #1 <br />June 29, 2005 <br />5 ~~' <br /> <br />SUN 3 ~) 2C05 <br />'~j Diuisiua of Mircroia & Goclogi <br />$688.00 (Due on or before your anniversary date) <br />Montrose <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_subrrtit~h_e annual fee. a rep9rk ansl map showine_tl~x~t 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 year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal rennrt and anm~al rennrt main to this form. Please note that an <br />adequately labeled map that clearly delineates and iucludes the above elements may sufface for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Nick H. Gray <br />Permittee Name: Nick H. Gray <br />Address: 584 65.30 Rd. <br />Montrose, CO 81401 <br />Phone Number: (970) 249-9436 <br />Fax Number: - ' ~ _ _ _ _ . _ _ . __ _ . _ , <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 enclosed. <br />N-~-eart~~ ..e i,~~rsi/V/C~c~~ <br />Si afore of Corp rate Off er, Own , or Des' ee <br />~n-a/~~S <br />Date o <br />