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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />Big R Construction Company <br />M-1988-052 <br />Big R Pit <br />August 16, 2003 <br />RECEIVED <br />AUG 01 ?003 <br />Division ~t I yinefats and CeologY <br />$281.00 (Due on or before your anniversary date) <br />Elbert <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 />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 ynnr revised written anneal rennrt and anneal report main 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: Rick L. Hunt <br />Permittee Name: Big R Construction Company <br />Address: 43160 CR 17-21 <br />Elizabeth, CO 80107 <br />_--R1}one-Number:.. _(303).646-6486-_ _-~_ <br />Fax Number: (303) 646-9233 <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 />ature of Corporate Ocf-f~icer, Owen~er, or Designee <br />II t[e <br />M:IPERMITMASTERD000MEN75Vv1-A F-0) <br /> <br />