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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />El Paso County <br />M-1980-189 <br />Yoder <br />October 23, 2002 <br />~~. <br />RECEIVED <br />OCT 2 i 2002 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />El Paso <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 shall submit-the annual'fee-a report and`map"showirig the extent of current'i3isturbances to affected -- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, [he 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 resort and annual resort man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: George P. Sugars <br />Permittee Name: El Paso County <br />Address: 3460 N. Marksheffel Rd. <br /> Colorado Springs, CO 80922 <br />Phone Number. _ (71.9-) 520-6860 ------ <br />Fax Number: (719) 520-6878 <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 <br />enclosed. <br /><~~~ <br />Signature of Corporate/Officer, Owner, or Designee <br />/~ /P'/a v <br />Date ~~ <br />M:~PERMITMASTERD000 MENTSUI-AF-04 <br />