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<br />~~C~IV~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kiowa County <br />M-1991-074 <br />Barnett Pit <br />November 12, 2003 <br />OCT 2 21003 <br />nivision of Minerals and Geolo~~~ <br />$688.00 (Due on or before your anniversary date) <br />[{iowa <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 />operatsr'sfia21-svbmit-the'atmnatfee, a-reporrand'map-shawingthe e3ctent-afcurrem'dismrbances-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 ~nnr revised written annnal report and annual re~nrt mar 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 />Permittee Contact: Rodney Hopkins <br />Permittee Name: <br />Address: <br />Kiowa County <br />P.O. Box 100 <br />Eads, CO 81036 <br />_- _ --Phone-Number:-_ .(7I9}438-5810- <br />Fax Number: (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 Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMITUTASTERDOCUMEMSVN-AF-04 <br />