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<br />~~~.~ -. <br />ANNUAf. FFF. and REPORT RF.OiTF.ST <br />JAN 2 L i:„~5 <br />PERMIT"I'EE NAME: Las AnlmaS County Division of ~:::ncr! _ G^oluil' <br />PERMIT NO.: M-1997-100 <br />OPERATION NAME: Branson Gravel Pit <br />ANNP/ERSARY DATE: January 16, 2005 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) ~~ <br />COUNTY: Las Animas <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an <br />^`operatbr shall'.submlf~the=annual_fee,_'a r~por[ a~ map showing tfie-'e-tx ent`of curren~disturfian~es to_aff~cY2iI"-_ _-- <br />land, reclamation accomplished to date and during the preceding yeaz, 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 yeaz, if any. <br />Please attach y~nr revised written annual report and annual report 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 <br />report. <br />Division records indicate the following pertnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Phi] Dorenkamp <br />Petmittee Name: Las Animas County <br />Address: 2000 N. Linden Ave. <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-2931 <br />Fax Number: (719) 846-0434 <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 />Si lure of Corporate Officer, Own , or esignec <br />~o~ <br />Date / <br />M:~PERMI7lMASTERDOCUMENTSNr-AF-04 <br />