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• III IIIIIIIIIIIIIIII • <br />999 <br />ANNUAL REPORT <br />PERMITTEE NAME: Jake Kauffman & Sons, Inc. <br />PERMff NO.: M-1978-327 <br />OPERATION NAME: Kauffman Pit <br />ANNIVERSARY DATE: May 14, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $550.00 <br />COUNTY: Larimer <br />RECEIVE® <br />MAY 0 2 2000 <br />Division of Minerals &Ge0logy <br />1'A161 <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an operator shall <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land; <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated <br />to occur during the upcoming year, reclamation that will be performed during the coming year, the <br />dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this annual report. Please <br />note that an adequately labeled nrnp that clearly delineates and includes the ubove elements may <br />suffice jor n written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: /~,Ji~i A!/~/~~// <br />Address: ~/~ ~ .SG/E' ~~ <br />~~j~ l~o~ ~jo S053z_ <br />Company:~/~~,~i 4~~-LiY~ <br />Phone No.: ~~l ) ~~ 7 -//S~~ <br />FAX No.: (q~U) ~~0 7- 7 98s <br />If there are additional comments and/or information that should be provided to the Division, please <br />provide it on a separate sheet and attach it to this report form along with your map and/or written <br />report. <br />_1!C~~..~z' ~~%~~r~~ f - ~f/ - ADD d <br />Signature~rpor Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />A1:~PERA71N1ASTERD000MENTSU7 AF-01 <br />