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<br />RECEIVED <br />JUN 1 2 2003 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rio Blanco County <br />M-2000-073 <br />Shults Gravel Pit <br />June 27, 2003 <br />Division of Minerals and Gealagy <br />$281.00 (Due on or before your anniversary date) <br />Rio Blanco <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 distuiliances 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 yrn~r revised written annual renort and anmral report m t to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may sufftce 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: Jerry Steele <br />Permittee Name: <br />Address: <br />Fax Number: (970) 878-3396 <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 />Signatur of Corpor e O ficer, Owner, or Designee <br />,, -t'3 3 <br />Date <br />Rio Blanco County <br />570 2nd St. <br />Meeker, CO 81641 <br />M:\PERM ITN~IASTERDOCUMENTSVvI-AF-pq <br />