2006-04-19_REPORT - M1994092 (2)

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Fpr 19 06 03:O5p PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNIVERSARY DATE: ANNUAL FEE DUE: COUNTY: FREMOMT COUNTY 7192767321 ANNiiAi. FF.F. and RF,P[)RT R~i1FCT APRs ~ J ?u{t~ Division ai ~,;,;, - Fremont County a.. - M-1994-092 Iran Mountain Road Gravel Pit January 23, 2006 $281.00 (Due on or before your anniversary date) Fremont p.2 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 shall submit the annual lee, a report and map showing the extent of current disturbances to affected land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming yeaz, reclamation that will be performed during the coming year, the dates for the beginning of active operations, anct the date active operations ceased for the year, if any. Please attach ,XQpr revised written annual ~nrf and sonnet re~nrt main to this form. Please ItOte that ari adequately labeled map that clearly delineates and includes the above elements may since for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Paul Garrett Permittee Name: Fremont County Address: Phone Number: Fax Number: Fremont Cowity Commissioners 615 Macon Ave., Room #105 Canon City, CO 81212 (719) 276-7320 {719) 275-7626 If you have additional comments and/or information that should be provided to the Division, please provide it below, or attach it to this form along with your written report and map. Annual Report instructions are ,, enclosed. ~T~~ Signature of~ O icer, Owner, or Designee l~///~~~ Date T ~l .J"