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.~ <br />04~ ~3 <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Fremont County <br />M-1990-047 <br />Quargmire Creek <br />January 20, 2004 <br />RECEIVED <br />JAN 212004 <br />Division of Minerals & Geology <br />$281.00 (Due on or before your anniversary date) <br />Fremont <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 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 during t e upcoming year, reclamation that wtll- e~performed-during the co`ming year, the dates -for the -- - <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />please attac~ynur revised written annual rennrt and annual re nrn t mad to this fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: II <br />Permittee Contact: Keith McNew ~ u 1~-- ~7Q 22eT~ <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room #105 <br />Canon City, CO 81212 <br />Phnne Numher:_(714.)2Z6-2300 (7/9~ 9 ~f-2 -!~.~3_SF . _ _ __ <br />Fax Number: (719) 275-7626 <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 />S nature of Corporate O ficer, Owner, or Designee <br />/-1.3-ov <br />Date <br />M:IPERM ITU1ASTERDO W M ENTS WI-AF-04 <br />