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f ~~~ ~~~~~~~~~~~~~ ~~~ <br /> 999 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Saguache County <br />t\f-1977-568 <br />Cooper Pit <br />November 25, 2001 <br />REi~EIVED <br />Ncr 2 s toot <br />Division al Minerals and CeoloBY <br />5688.00 (Due on or before your anniversary date) <br />Saguache <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 <br />operator shall submit the annual fee, a repot 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 />occur during the 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 annual report and annual report map to this form. Please note that act <br />adequately labeled reap tknt clearly delineates and includes the above elements may since far a teritten <br />report. <br />Division records indicate the following permittee contact information. Please verify and mab.e any necessary <br />changes: <br />Permittee Contact-. John Y. Ungefug <br />Permittee Name: Saguache County <br />Address: P.O. Box 476 <br />Saguache, CO 81 149 <br />Phone Number: (7f9)655-2554 <br />Fax Number: (719) 655-2543 <br />If you have additional comments and/or information that should be provided to the Division, i~lease provide it <br />below or attach it to this form along with your written report and map. Annual Repots instructions are <br />enclosed. <br />ign ure of Corporarte Offi ne <br />ll~~l o! <br />Date <br />hI:~PERiV ITV.ITSTERD000hI ENTSNf ~AF-M <br />U~d1T / FUP~ 1~_~ 3,1~ <br />APPROVAL <br />