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-~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Prowers County <br />M-1984-134 <br />Randy Shaw Pit <br />August 31, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Prowers <br />RECEIVED <br />AUG 2 2 2002 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-ll6 or C.R.S. 34-32-ll6, each yeaz, on the anniversary date of the permit, an <br />__ _operator_shall submit.the_annual fee, a,report 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 yeaz, 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 an <br />adequately Zabeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permit[ee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mark Prowers <br />Permittee Name: Prowers County <br />Address: 109 E. Sherman St. <br />ProeJ.a~.4 Coctiv%v <br />/D y ~ .S`iei^mGn .Sf <br />Lamar, CO 81052 L.Lf Ir. M' f~ ~~n.S ~ <br />Phone Number: (719) 336-5536 -- 7~ ~/ ~ 3 3¢ - 55-3 L <br />Fax Number: (719) 336-9633 7,[y - 3 3G -5-53 G <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Officer o Owner <br />~-- ~-.G2 <br />Date <br />M:~PERMITVNASTERDOCUMF,,NTSN-i-AF-04 <br />