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RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Dilleys Sand & Gravel <br />M-1981-004 <br />Ayers Pit <br />February 2, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Morgan <br />JAN.3 1 2003 <br />Division of Minerals and Geobgy <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 />rec ama ion acco p o e durni g ttse'p~ding year-crew-distarban~es-that-are-anticipated-t~ 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 Ynur revised written anneal re,~nrt and annual rennrt m t to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may sujf ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Vernon Dilley <br />Permittee Name: Dilleys Sand & Gravel <br />Address: 1914 Edmunds St. <br /> P.O. Box 125 <br /> Brush, CO 80723 <br />Phone Number: (970) 842-2810 <br />Fax Number: (970} 842-2284 <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 />ignature of Corporate Officer, Own o Designee <br />_~- a 9- a 3 <br />Date <br />M:NERMINIASTERD000MENTSU4-AF-0 ~ <br />