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<br />3~~1~03 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />James H & Kathleen H Ross <br />M-1990-134 <br />Ross Pit <br />April 10, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Moffat <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 />~eelamation-accomplished-te-date-and-daring~he_preceding_yearrne~disturbances .that .are_anticipated_to_occtu <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 />Plracr attach vour reviced written anm~al rennet and anneal rennet man to thic form. 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 petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bud Bower <br />Permittee Name: James H & Kathleen H Ross <br />Address: <br />Phone Number: <br />Fax Number: <br />595 Taylor St. <br />Craig, CO 81625 <br />(970) 824-2793 <br />(970)824-9410 <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 />lla[e <br />M:\PERM 1"MAASTERDOCUM ENTSVvI-AF-01 <br />