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PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Patrick L. Cugnini <br />M-1986-061 <br />Cugnini Gravel Pit <br />July 21, 2003 <br />RECE~VEp <br />APR ?'y ~ <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />La Plata <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ~uur revised written anmlal r~nrt and annnal rennrt ma,~ to this fnrm_ Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Per[nittee Contact: Marcia L. Talvitie <br />Permittee Name: -]ELSlriek-~-C'tt$aitri- 0{~Sf/e SWGrottp„ZM. dpi F1Xr~COrncrS NIaJIPi7aS <br />Address: <br />P.O. Box 2707 <br />Durango, CO 81302-2707 <br />Phone Number: (970) 247-2172 <br />Fax Number: ~97D~ .~~/~- 3<03~ <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 enclosed. <br />~ `~IR~~G~U~' <br />Signature of Corporate Officer, Owner, or Designee <br />.210 ~pri! ,u~9 <br />Date <br />M:IPERMITMASTERD000MENTSVN-AF-01 <br />