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-_ *,, <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~~~ <br />t~ ANNiiAi. FF.F. and RF,P(lRT RF.OiTF,ST <br />City of Lamar <br />/M-1987-078 <br />Lamar Park Grav Pit <br />June 24, 2006 <br />~°~~'~~~/ED <br />,~ MAY 2 5 2006 <br />'- Oivisian of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Prowers <br />~~ <br />According to C,R.S. 34c32.5.116 or .C.R.S: -34-32-116,-each year; on the anhiversary 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 active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anmral re,Pnrf and annnal r n~ rt main to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Patrick Masan <br />Permittee Name: City of Lamar <br />Address: 102 E. Parmenter St. <br />Lamar, CO 81052 <br />` - "-Phone Number: (719) 336-4495 <br />Fax Number: (719) 336-4404 <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 />~CJ'~-w"l/ 'iP~ <br />Signature of Corporate Officer, Owner, or Designee <br />8- ~~ <br />Dale <br />MiPERMITVdASTEADOCUMENTSIhI-AF-04 <br />