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<br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Park Couuty <br />PERMIT NO.: M-1995-021 <br />OPERATION NAME: Chaparral Pit <br />ANNIVERSARY DATE: Apri124, 2002 <br />RECEIVED <br />MAR 2 8 2002 <br />Division of Minerals and Geology <br />ANNUAL FEE: $281.00 (Due on or before anniversary date) <br />COUNTY: Park <br />According to C.R.S. 34-32.5 or C.R.S. 34-32-116, each year. On the anniversary date of <br />the permit, an operator shall submit the annual fee, a report and map showing the extent <br />of current disturbances to affected land, reclamation accomplished to date and during the <br />preceding yeaz, new disturbances that are anticipated to occur during the upcoming yeaz, <br />the dates for the beginning of active operations, and the date active operations ceased for <br />the yeaz, if any. <br />Please attach your revised written annual report and annual resort maa to this <br />form. Please note that an adequately labeled map that clearly delineates and includes <br />the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and <br />make any necessary changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Dou Keith <br />Pazk Countv <br />P.O. Box 147 <br />Faim lay, CO.,_80440 <br />719 836-4270 <br />719 836-4275 <br />If you have additional comments and/or information that should be provided to the <br />Division, please provide it below or attach it to this form along with your written report <br />and map~Ann~ Refit in~ktuctions aze enclosed. ~ irfk Amy <br />or Owner <br /> <br />Date <br />