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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNiiAT, FF,F, and RF.PnRT RF,niJF.ST <br />RECEIVED <br />Thomas F & Ginger L Latham <br />M-1981-058 <br />Del3eque Gravel Pit <br />September 7, 2003 <br />SEP 2 4 ~ <br />Division sf Minerals and G0o10aY <br />$688.00 (Due on or before your anniversary date) <br />Mesa <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator <br />___ _shall_subttut_the_annuaLfee,_a_report_and_map_showing_the_extent_of current_disturbances_to_affected_land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during [he coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal report and annual rennrt man to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Harold F. Elam <br />Permittee Name: Thomas F & Ginger L Latham <br />Address: 1225 S. 7th St. <br />Grand Junction, CO 81501 <br />Phone Number: (970) 242-5370 <br />_ Fax Number: (970) 245-7716 <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 />i <br />ignature of Corporate Officer, Owner, or Designee <br />Harold F. Elam, President <br />/ 9- S.~ z` - o~ <br />Date <br />M:~PERMINIASTERDOCUMENTSUI-AF-01 <br />