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AY\1!_11. FF'F' and RF'POR'1' ItF(~I F'tiT ` "~ <br />RECf `'''`-~ <br />PGRM[1'I'GG NAME: Sulbcrl; Gravel LL(' 9 2OOA <br />PGRMI'I' NU.: ~,-198,-033 MAR 2 <br />i ~ Divisron o1 µinui~. i• Gnotn9'I <br />of I:RArlan Nn~ll:: Solberg 1 it <br />ANNIYIiRSARY U:\"fli: Aprfl 7, 2003 <br />ANNUAL 1~1.G DUG: 5688.00 (Uue un ur before your anuivcnary date) <br />CQUN"fl': EI 1'usu <br />Acnrrdmg to ('.K.J. 33-]2.5-1 IG or C.R.J. 33-32.116, each ycur, un the unmversary• date u(the pernttt, un operator <br />shall subnut the annual tic, a report and map shuwmg the catent ul current dtslurb:uucs to attccted land, <br />rrclamatiun accumpluhed to date and dunng the prcccding ycur, new disturbmucs that are anucipated to occur <br />dunng the upcoming yrar, rcclansruon that utll be pcriLrnxd dunng the coming year, the dates for the beginning <br />o(acMC oprr.aum,, and thr d:uc a~uac opcruunu ccaxd tiv the }car, it any. <br />1'Icv.e ntlurh ~nnr rc~i~rrl nriuru •~nnu•~1 whorl ~~nd •~nn ~nl rrhnrt m•~h [n rhi~ f~ nu /~(i~GSC tlUfe (hut t1/1 <br />~uhv/tauc/t' l~nc~lr~l atop llad! ~ l~,u'Ir drLm ~u.;~ uml iwiudre rhr <rhovr .•Icer,•~rb m;n' iuJ/;rr /rn~ ~r rrvi!!en rc'/~arr. <br />Divwiun records indicate the following Ixmuttcc eunwcl infumwtiun, Please verily and rrurkc any nccessary• <br />ehwtges: <br />Pcnnrttec C'unwct: Bob Sullxvg <br />Permntce Name: Solberg Gravel LL(' <br />Addrrss: 13735 (iuricll Rd. <br />halcun, CO 811531 <br />Phone Nunilxr: (719) GS3-3195 <br />PuxNumtxr: (719)G83-3373 <br />II }'uu have adduwnal comments and/or intorntation that should he provided to the Division, please provide it <br />bcluw ur attach a to thts tbrm along with your written report and map. Annual Report instruchuns arc enclosed. <br />~r <br />~1~~~'" - <br />Jtgnature of ('urlx)rut~ er, Owner, ur Desrgn~ro <br />Date <br />