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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNiiAi, FF,F, and RF.PnRT RF.niTF.ST 55_~,,F ®®~~°° <br />RLV~~ V G® <br />Huerfano County <br />M-2001-106 <br />Orlando Pit <br />December 18, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Huerfano <br />DEC 12 2003 <br />~IVISIOR of Minerals and Geology <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 <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 annual rennrt 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 <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bill Brunelli <br />Permittee Name: Huerfano County <br />Address: ~1$3$-R~6Bd1~1- 4t11 Ttain Srracr, Sni ~Ol <br /> Walsenburg, CO 81089 <br />Phone Number: " (719) 738-2420 <br />Fax Number: (719) 738-3996 <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 />~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />Charles L. Montoya, Chairman <br />Date <br />M:IPERMITNIASTERDOCUMENTSU1-AF-04 <br />