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-~ <br /> ANNUAL FEE and REPORT RE UE T <br /> ECEIVED <br />PERMITTEE NAME: Prowers County AUG 2 2 2002 <br />PERMIT' NO.: M-1984-136 <br /> Division of Minerals and Geology <br />OPERATION NAME: Brann Pit <br />ANNNERSARY DATE: August 31, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <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-currem disturbances t~ affec[ed° <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 yeaz, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report maa to this form. Please note that ari <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: Mark Dorenkamp <br />Permittee Name: Prowers County <br />Address: 109 E. Sherman St. <br /> Lamar, CO 81052 <br />Phone Number: (719) 336-5536 <br />Fax Number: (719) 336-9633 <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 ins[mc[ions are <br />enclosed. <br />~~v~ <br />Signature of Corporate Officer o Owner <br />Date <br />M:NERMI7IMASTERD000MEMSVv7-AF-04 <br />