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~II ~II~II~I~I~~~~II <br />ANNUAL REPORT <br />PERMTTTEE NAME: IVlontrose County <br />PERMIT NO.: M- ~3 - ~ `~ Ez, <br />OPERATION NAME: 1~I2 A L ~, T <br />ANNIVERSARY DATE: / /~o / 9y' <br /> <br />Mgy~cF/~'F~ <br />oviso 14199 <br />n otM~ra~ & G~ <br />~Y <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $ SSC~. OCR <br />COUNTY: Montrose <br />~~~~ ~~ <br />C~~ `5'6 <br />According to C.R.S. 34-32-I 16(3)(a), 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 <br />to affected land, rec]amation accomplished to date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />annual report. Please Wore that an adequately labeled map that clearly delineates and <br />includes the above elements may suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />ContactNa~le:7-_y7~/~ /`"V//SC~!'~ <br />Address: ~~l~r~S//~/~.~~ <br />,C~1~~~ rdy ~~Y~z_ <br />Company:~~~irlf/>_'J,rl C.Ltiir~/ <br />T <br />Phone No.: (Gl7b ) ~C/~- 77SS <br />Fax No.: (970 J ~~/5~77~0 <br />If there aze additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />Sig/na ure of Corporate Officer, or Owner <br />`~ ~~ C ~' <br />Date <br />INSTRUCTIONS ON BACK <br />