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RECEIVE® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rio Blanco County <br />M-1998-054 <br />East Douglas Creek Gravel Pit <br />October 5, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Rio Blanco <br />OCT 16 2~3 <br />Division of Minerals and Deolagy <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 s a su~mii fhe annual-fee, a report and map showing the exte~ cf uirent disturbances to a ect~~ <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 yl}nr revised written annual rennrt and annual rennrt m ~n fn this form- p/ease 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: Jerry Steele <br />Permittee Name: Rio Blanco County <br />Address: 570 2nd St. <br />Meeker, CO 81641 <br />Phone Number: (970) 878-5601 <br />Fax Number: (970) 878-3396 <br />If you have additional cotnments 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 />Signa of Cor rate f tcer, Owner, or Designee <br />9-2 ~- 03 <br />Date <br />M:IPERMITNIASTERDOCUMENTSV~A-AF-04 <br />