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<br />f <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Elam Construction, Inc. <br />M-1999-076 <br />Highway 50 Borrow Area No. 2 <br />August 5, 2003 <br />$438.00 (Due on or before your anniversary date) <br />Mesa <br />RECEIVED <br />SEP t~ $1~p3 <br />Division et Minerals and CeolodY <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 />smell submit the annual fee, a report and map showing the extent- of current d~s2uibances to affec[ed ant d, <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 report and anneal rennrt m ~n to thin form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice jor 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: Elam Construction, Inc. <br />Address: 1225 S. 7th St. <br />Grand Junction, CO 81501 <br />(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 />`'~ /~~~ <br />Signature of C"orp~io(r~at/e Officer, Owner, or Designee <br />Harold F. Elam, President <br />.Sa,,, t 3, p~ <br />Date <br />M:NERMI'MIASTERD000MENTSVN-AF-01 <br />