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- ; Ill IIIIIIIIIIIIIIII <br />ANNUAL REPORT <br />PERMITTEE NAME: Fremont County <br />PERMIT NO.: rM-OJ9-033 <br />OPERATION NAME: How.a.RV C-RE:e-k Pvt'~ ~'Rr~ 2 <br />ANNIVERSARY DATE: 1y1R~Y 2(y2000 <br />ANNUAL FEE DUE UN ANNIVERSARY DATE: $225.00 <br />COUNTY: Fremont <br />• <br />FiECEIVE® <br />MAY 2 6 2000 <br />pivision of Minerals &Ge0i0gy <br />1~~17i <br />According to C.K.S. 34-32-1(ti(3)(aj, each year; on the atwiversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of curent disturbances <br />to affected land, reclamation accomplished to date and during the preceding yeaz, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the yeaz, if any. <br />Please note that art adequately labeled trtap that clearly delineates and includes the above <br />elements +rwy suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: ~ ro ~h-.e_o Company: t~Wt'rG ~~ <br />Address: ~D~aurc 3?ig PhoneNo.:S ~'jO~) 9L1'Z`~f1~-, <br />~~ e-o 7~irw , CU ~ 11.Z3 FAX No.: l ~~ ) °~s'Z-' 9'1~ 8 <br />[f there are additional cotmnents and/or information that should be provided to the Division, <br />please provide it on a sepazate sheet and attach it to this report form along with your map and/or <br />written report. <br />Signature of Corporate Officer, or caner Date <br />INSTRUCTIONS ON BACK <br />