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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~! a~ <br />ANNUAL F 1?~tr ~ PORT RE VEST <br />~ ®~ <br />Larry L. Chartier <br />M-1984-040 <br />Chartier Pit <br />July 19, 2002 <br /> <br />RECE6I~E® <br />JUL 29 2002 <br />Qlrtsf9a of Minerals and GeoloBY <br />$281.00 (Due on or before your anniversary date) <br />Morgan <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversazy date of the permit, an operator <br />shall_submit_the _annual-fee,_a-report-and-map-showing-tlu;=extent-Hof-ci~rren~clis#xbanees- to affected ~land,- <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o 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 your revised written annual report and annual report map to this form. Please note chat an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Larry L. Chartier <br />Lazry L. Chartier <br />21305 Road 28.5 <br />Brush, CO 80723 <br />_ Phone Number: (970) 842-5657 <br />Fax Number: <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 />Signature of orporate Officer or Owner <br />~---F7 -! ~ -- o'z <br />Date <br />M:tPERMrnMASTERDOCUMEMSIM-AFOI <br />