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Ir <br />ANNUAL FEE and REPORT REQUEST <br />/_o~e/.~ j~/XifYl s~~~ <br />~~iS- <br />~.~,~,- Sao 3 . <br />ERMITTEE N <br />ME F <br />t C <br />t RECEIVED <br />: <br />P <br />A remon <br />oun <br />y <br />PERMIT NO.: M-1994-118 JUL 2 3 2Q~!? <br />OPERATION NAME: Phantom Canyon Pit Diuisian of Minerals and G <br />( <br /> ea <br />ogy <br />ANNNERSARY DATE; August 8, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Teller <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 />operatQl Sh~1_submit-the annual fee, a report and map showing the extent of current disturbances _t_o 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, [he 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 labeled map that clearly delineates and Includes the above elements may suffice for a writteta <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: CF.PRcon[act first name CF.PR.contact last name <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />615 Macon Ave., Room #105 <br />Canon City, CO 81212 <br />Phone Number: (719) 276-7320 <br />Fax Number: (719) 275-7626 <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 />/~/, <br />Sigtt'ature of Corporate Officer or Owner <br />JJ %~ %~o Z <br />Date <br />e~l•y~.y~4z. ~5 tD~ <br />M:tPERM ITVNASTERDOCUM EMSthI-AF-04 <br />