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<br />ANN[iAi, FF.F. and Ri'PORT RF.11i1F,ST <br />J~~~~V~ I~'t~ <br />PERMITTEE NAME: Elbert County <br />PERMIT NO.: M-2001-056 Q~T 2 1 2OO3 <br />OPERATION NAME: Belveal Gravel Pit p~yision of Minerals and Geoloau <br />ANNIVERSARY DATE: November 9, 2003 <br />ANNUAL FEE DUE: $28].00 (Due on or before your anniversary date) <br />COUNTY: Elbert <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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected <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 ynnr rrvised written ann gal renort and annual rennrt map.tn Chic form. Please note that at <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: Tim Sheridan <br />Petmittee Name: Elbert County <br />Address: <br />Phone Number: <br />Fax Number: <br />809 Ute Ave <br />Simla, CO 80835 <br />(719)541-2268 <br />(719)541-2826 <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 />enclosed. <br />~~~ <br />Signature of orporate-9ff ° r Owner, or Designee <br />Date <br />M:~PERM I"MIASTERDOCUM ENTS~hi-AF.04 <br />