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<br /> ANNiIAi. FF,F, and REPORT RF.OiiF.ST <br />RECEIVED <br />PERMITTEENAME: KiowaCounty <br />PERMIT NO.: M-1983-116 AUG 0 1 2003 <br />OPERATION NAME: Gentz Gravel Pit pryision ~f Minerals and Geology <br />ANNIVERSARY DATE: August 25, 2003 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <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 />operator shall-submit the annual- fee,- a ieport and map showing the extent of current disturbances to affected- <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 anneal rennrt m ~ 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 /> <br />Permittee Contact: Rodney Hopkins <br />Permittee Name: <br />Address: <br />Kiowa County <br />Phone Number: <br />Fax Number: <br />P.O. Box 100 <br />Eads, CO 81036 <br />(719) 438-5810 <br />(719)438-5327 <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 />Signature of Co rate Of rcer, Owner, or Designee <br />~7 - ~ ~-63 <br />Date <br />M:IPERMITMASTER DOCUMENTSIM-AF-04 <br /> <br />