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<br />~ECEruEfl <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kiowa County <br />M-1991-078 <br />Peters Pit <br />February 4, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Crowley <br />JAN 3 :f yQ03 <br />Division of Minerals and Geology <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 sulimifthe annual fee, a~teport 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 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 />Pl ae sea „ttarh y~y~r revised written annnal report and annual re^nrjma~ to this form. Please no7e 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: Rick Spady <br />Permittee Name: Kiowa County <br />Address: P.O. Box 100 <br />Phone Number: <br />Fax Number: <br />Eads, CO 81036 <br />(719)438-5810 <br />(719)438-5327 <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. Annua] Report instructions are <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />l-~5 ~3 <br />Date <br />M:IPERMITMASTERD000MENTSUI-AF-04 <br />