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<br />RECEIVED <br />MAY 1 1 1pp3 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Cecil C Powell <br />M-1995-012 <br />Powell's Gravel Pit <br />May 12, 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 <br />Division of Minerals and Geology <br />shad-submit- [fieannuat ee, a repo an map showing the extent of current dts[urbances 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 the 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 ymrr revised written anmral report and annnal refit m ~n 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: Cecil C. Powell <br />Permittee Name: <br />Address: <br />Cecil C Powell <br />P.O. Box 23 <br /> <br />Dinosaur, CO 81610 p ; n o &,.au /' 1 fit) ~t (U / O <br />Phone Number:. (970) 374-2329. _ _ _ ry-> fj - 3'~ ~/ - 2- 3 -Z °/ - - <br />Fax Number: <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 />~~<c~~~ <br />Signature o~orporate Officer, Owner, or Designee <br />Date <br />M:IPERMn1MASTERDOCUMENTSIM-AF-01 <br />