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4 <br />PERMITTE:E NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVER~iARY DATE <br />ANNUAL E'EE DUE: <br />COUNTY: <br />CAMAS Colorado, Inc. <br />M-1989-029 <br />Distel Farm Resource <br />December 7, 2000 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />RECD - ~~~ <br />APR 1: <br />Division of Miner .. .. _~.:o6t' <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 />operator sha!I submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur Burin€; 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 vour revised written annual reuort and annual reuort mau to this form. P/ense note thnt un <br />udeyuntely iubeled map Thal c(enrly delineates and includes the ubore e/emerrls nruy suffice for a wrrtlen <br />report. <br />Division recxds indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Michael C. Refer <br />Permittee Name: CAMAS Colorado, Inc. <br />Address: 3605 S. Teller St. <br />Lakewood, CO 80235 <br />Phone Number: (303) 985-1070 <br />Fax Number: (303) 716-5299 <br />If you have additional comments and/or information that should be provided to [Ite Division, please provide it <br />below or atttich it to this form along with your written report and ntap. Annual Report instructions are <br />enclosed. <br />Signature of C rporate Officer or Owner <br />Date <br /> <br />ANNUAL FEE and REPORT REQUEST <br />M NERMIT~MASTER DOCl1MENT5U1~AF-01 <br />