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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />DG Huskin Construction Company <br />M-2000-118 <br />Pino Pit <br />November 15, 2002 <br />RECEIVED <br />NOV 1 2 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Huerfano <br />According to 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 repoR and map showing the extent of current disturbances to affected ]and, <br />___ reclamation_accomplished_to dateand_during-the_preceding_year,_ne~disturbance~that =re-antic-ipated-te-occur-- - - - <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for [he beginning <br />of active operations, and the date active operations ceased for [he year, if any. <br />Please attach vour 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 the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Richard L. Pounds <br />Permittee Name: DG Huskin Construction Company <br />Address: P.O. Box 61 <br />Phone Number: <br />Fax Number: <br />Westmore, CO 81253 <br />(719)784-0415 <br />(719)546-2143 <br />If you have additional comments and/or information [hat should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />,(/L-~ <br />Signature of Corpo [e Officer, Owner, or Designee <br />// /d 7~~ y <br />Date <br />M'.~PERMITVvI ASTERDOCUMENTSU~I-AF-01 <br />