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RECEf VED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Tom and Regina Farmer <br />M-1983-159 <br />Gleason Pit <br />January 30, 2002 <br />FEB 0 1 2002 <br />Oivisian of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Montrose <br />According io 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 />shall submit_the_annual fee, a report and map showing the extent of current disturbances [o affected land, <br />reclamation accomplished to date and during the preceding year; new disturbances that are anticipated [o-occur f <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 yeaz, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Regina Farmer <br />Permittee Name: Tom and Regina Farmer <br />Address: P.O. Box 39 <br />Redvale, CO 81431 <br />Phone Number: (970) 327-4316 <br />^^- ----Fax-Ar[rmber: - -- (970)-327-0350 - <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 />Q.wa~m,L1 ~('~~tn~t.eJ~ <br />Sigr~reatu ofof Co~iporate Officer or Owner <br />g- o~ <br />Date <br />M:(PERMIT\MASTERDOCl1MENTSNI-AF-01 <br /> <br />