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David Goss <br />M-1985-140 <br />Goss Sand & Gravel <br />January 24, 2006 <br />RECFP~,/E~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />k <br />JAN 0 9 2006 <br />Division et Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />EI Paso <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 />reclamation accomplished 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 annual rennrt and anneal reo~rt map to this form. Please note that an <br />adeguatel abe[ed map hat clearly delineates and include the above elements may suffice jor a written report. <br />Division records indicate the Mowing permitte c act information. Please verify and make any necessary <br />changes: <br />Permittee Contact: David Goss <br />Permittee Name: David Goss <br />Address: Rt. 2, 6759 Ellicott Hwy. <br />Calhan, CO 80808 <br />Phone Number: (719) 683-2415 <br />Fax Number: (719) 683-3290 ~~o~,.-L_ <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 />w`ftifi~J ~G<~'~a~7~'~8 <br />Signature of Corpor>ate facer, Owner, or Designee <br />J / 3 ~d .6 <br />Date <br />