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RECEIVED <br />MAR 2 0 2001 <br />ANNUAL FEE and REPORT REQUEST ~1vision of Minerals and cealagy <br />PERMITCEE NAME: Park County <br />PERMIT NO.: M-1980-013 <br />OPERATION NAME: Elkhorn Springs Pit <br />ANNIVERSARY DATE: April 1, 2001 <br />ANNUAL FEE: SZ81.00 (Due on or before anniversary date) <br />COUNTY: Park <br />According to C.R.S. 34-32.5 or C.R.S. 34-32-116, each year. On the anniversary date of <br />the permit, an operator shall submit the annual fee, a repoR and map showing the extent <br />of current disturbances to affected land, reclamation accomplished to date amd during the <br />preceding year, new disturbances that are anticipated to occur during the upcoming year, <br />the dates for the beginning of active operatioms, and the date active operations ceased for <br />the year, if any. <br />form. Please note that an adequately labeled map i <br />the above elements may suffice jor a written report. <br />Division records indicate the following pennittce contact information. Please verify and <br />make any necessary changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />~J c~ul~ ~E~TN <br />~ ~ <br />~Q C <br />~- O <br />270 <br />71 5 <br />If you have additional comments and/or information that should be provided to the <br />Division, please provide it below or attach it to this form along with your written repoR <br />and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer or Owner <br />Date <br />