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r, - 5 <br />~ V <br />'.. ,,.~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Solberg Gravel LLC <br />M-1981-044 <br />Solberg Pit <br />April 7, 2002 <br />$688.00 (Due on or before your anniversary date) <br />EI Paso <br /> <br />OiYision of Minerals and Geolo9Y <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of [he permit, an operator <br />shall submit [he annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation-accomplished~to date and during the preceding year,-new-disturbances~thaC 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 your revised written annual report and annual report maa 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: Bob Solberg <br />Permittee Name: Solberg Gravel LLC <br />Address: <br />Phone Number: <br />Fax Number: <br />13745 Garrett Rd. <br />Falcon, CO 8083 ] <br />(719) 683-3198 <br />(719) 683-4373 <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 />~gna~orporate icer r Owner <br />Da e <br />M:~PFRM771MAST6RD000MENTSU1-AF-01 <br />