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A III IIIIIIIIIIIII III <br /> 999 RECEIVEC <br /> ANNUAL FEE and REPORT REQUEST <br /> APR 13 2001 <br /> PERMITTEE NAME: Robert D and Lavelle Corey Division of Minerals and Geology <br /> PERMIT NO.: M-1987-024 <br /> OPERATION NAME: Corey Gravel Pit#3 <br /> ANNIVERSARY DATE: April 17,2001 <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: Montrose <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning of activi o operations, and the date active operations ceased for the year, if any. <br /> Please attach you r revised written annual report and annual report main to this form. Please note that an <br /> adequately lahele map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records i idicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Per-mittee Contact: 4A+@h"W—R"— Richard G. Johnson <br /> Permittee Name: Robert D and Lavelle Corey <br /> Address: R.^. Box ,03 PO Box 3609 <br /> -g Grand Junction, CO 81502 <br /> Phone Number: (970) 243-4900 <br /> Fax Number: -(979)$� (970) 243-5945 <br /> If you have additic ial 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 /> nature of Co o e Officer or Owner <br /> Date <br /> M:TEMUTMASTERDOC N-FSW-AF-01 <br />