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'1'~'~" <br />A~wl~ <br />:~\'\l A1. F'FF' aml ItFPURT RI•Y)I FS'f <br />~~ <br />PIiRMITT81i NAME; I;ACA ('ounly ~'~ 2 K <br />PERM1'I' Nf7.: ~I-1978-225-1, <br /> <br />UI'f:KA IION NA11I•.: ~. y.., <br />McVey 1'il <br />ANNIVI:RSARI' 1);11 I~.; :1pril 28, 2004 <br />ANNUM. FI'.1~. UIIG: Y688.1111 (Uuc nn or before ymtr •rnnivenary datel <br />('Ul1N'I'ti': BaIA <br />According to ('.R.S. 34-32,5-I Ili or ('.R.S. 34-32-I IG, etch year, on the anniversary dote ol'the permit, an <br />uperouu ahnll nrbnw the annual Ice, a report anJ map showing the r~tent of current dtsturhancea u, allccted <br />land. reclamation uecomphshed to date and dunng the preceding your, new dtsurrbances that arc anucipatcd to <br />rxcur dunng the upcummp year, reclamation that will be perl'ornted dunng the coming year, the drucs lire the <br />beginning of aclnr operations, and the dale active olxrations ceased li+r the year, tf any. <br />F'Irncr Lttnch ~m+r rn~ianl writs n +nnunl report •~n 1 Lon cal r •pnrl nyp ro thic form Plr'a.~'e~ mole!/taf ern <br />urlryrrul~h LrhrA•J mule rlurr r(rurk drlinnurx acrd irulurlrs llrr uhner ~Icurrur.+ nrgt sullirr for a u•r•iucvr <br />rrpur! <br />Ihvtsion records indicate the titllowing petmittec contact inti>rmuuvn. Please verify and make any necessary <br />chunpcs: <br />Pcrmittec ('ontact: Troy ('rone <br />Pc•rmittce Name: Racu (-ounty <br />Address: 741 Mum SI. <br />Springfield. CO K 1073 <br />Phone Numlxr: (719) 523-6532 <br />I~as Numhcr: (719) 523-458.3 <br />If you have uddidunul comments and/or informAUOn that should be provided to the Division, please provide it <br />below or attach it to This form along with your wrttrn report and map. Annual Report instructions arc <br />l'nl'IUSCd. <br />y~ ~fttit_" <br />S matu ~ f Curlwrute Ofliccr, Owner, or Designee <br />Date , <br />~+. rrxnnrmnsrtarxx~r anr.~s~rnr•-a <br />