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~~ <br />~~ ANNiiAi, FF.F, and RF,P(lRT RF.t7iTFST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ W~ashington County <br />t/M-2004-021 <br />Starlin Pit <br />July 13,2006 <br />RECEIVE® <br />`~JUL 122006 <br />v ulylsion of Minerals and 6eulagy <br />$688.00 (Due on or before your anniversary date) <br />Washington <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 an_nual_fee, a report 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 ~nnr revised written anmral rennrt and anneal rrpprt main to this form- please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following petrnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bruce Johnson <br />Permittee Name: Washington County <br />Address: <br />Phone Number: <br />Fax Number: <br />150 Ash <br />Akron, CO 80720 <br />'.-~'~ 1 / t. S ~ <br />4~~n in ~ir,~ tA'~ <br />f 5-~ !45 ~ <br />~ X tW, . Cv ~ ~d ~ <br />(970) 345-2701 ~' >a)3~/S -~d37 <br />(970) 345-2702 CS' JO ~.~ t/~ ^~o S~ <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 />~~ <br />' / ~,r+~~l~~ Gtr ~~ <br />-lure of Corpor Officer, Owner, or Designee <br />r/~/ad~~ <br />Date <br />M:~PERMI7NrASTERDOCUMENT5NI-AF-04 <br />