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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Geroux Gravel <br />M-2000-059 <br />Geroux Gravel <br />February 22, 2005 <br />i ~ā€ž 0 :, 2CG5 <br />.'i~rision of i.~iā€ž r. L, 0 Gaalopy <br />$281.00 (Due on or before your anniversary date) <br />Custer <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 />-" -restat~satiarr'a~omptished-to'date-and-during-the-preceding-year; new-disturbances-that-are-anticipated-to-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 ynnr revised written anm~al report and annual r ort mAn to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Darrell Geroux <br />Permittee Name: Geroux Gravel <br />Address: 1100 CR 160 <br />Westcliffe, CO 81252 <br />Phone Number: (719) 783-2709 <br />Fax Number: (719) 783-2709 <br />.____ If you have additional comments and/or information that should be provided fo 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 />Signature of <br />or Designee <br />Date <br />