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<br />PERMITTEE NAME: Geroux Gravel <br />' RECEIVED <br />PERMTI <br />NO.: M-2000-059 <br />OPERATION NAME: Geroux Gravel FEB 1 12004 <br />ANNIVERSARY DATE: February 22, 2004 <br />Division at Minarals & Geology <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Custer <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 />- s'itatt-si[bmit-the-armttat-Pce; a-eeport--and=ir[ap-showing-the--eRte7it=cf~enrtent -disturbances=fo=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 ymrr revised written anmral report and anmral re~nrf m}~ to this form- please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Darrell Geroux <br />Permittee Name: Geroux Gravel <br />Address: 1100 CR 160 <br />Westcliffe, CO 81252 <br />Phone Nlunber:~.(719)_783_2709 ____~_ _ <br />Fax Number: (719) 783-2709 <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 />Signature of Corporate Officer, Owner, or II~'gtlee <br />~~ ~ ~! <br />Date <br />MiPERM[NIASTERDOCUMENTSh1-AF-01 <br />