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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Mask, LLC <br />M-2002-087 <br />Mask Ranch Gravel Pit <br />November 25, 2003 <br />RECE~yED <br />NOV 2 12003 <br />Division ~f Minerals end GeoloBY <br />$281.00 (Due on or before your anniversary date) <br />Archuleta <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 />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 ymm revised written anneal rennrt and anneal rennrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Dennis Walker <br />PetTrtittee Name: <br />Address: <br />Mask, LLC <br />P.O. Box 5356 <br />Pagosa Springs, CO 81447 <br />Phone Number: (970) 264-5742 <br />Fax <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 />~u/~1~'<!~ fit /irv~.cf <br />Signature of Corporate Officer, Owner, or Designee <br />~//iy/~ ~ <br />Dates <br />M:~PERMITUTASTERDOCUM ENTSVN-AF-01 <br />