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i <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Alamosa County <br />M-2001-108 <br />Alamosa County Pit No. 1 <br />February ZZ,2005 <br />JAN 3 1 ~ <br />Oivisign of fNmer0ls and Ge010gy <br />$281.00 (Due on or before your anniversary date) <br />Conejos <br />1~-k.~~ <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary data 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 />- -ocour during tFie 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 />Please attach your revised written annnal report and annual re~nrt m~ to this form. 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: <br />Permittee Contact: Phil West <br />Permittee Name: Alamosa County <br />Address: 8663 S. CR 109 <br />Alamosa, CO 81101 <br />Phone Number: (719) 589-6262 <br />Fax Number: - (719) 589-6063 - <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 />^ / <br />Si tore orporate Officer, Owner, or Designee <br />Date <br />M:~PERMITMASTERDOCUMENTSVN-AF-04 <br />