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n_ <br />SSS <br />FifCEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Delta County <br />M-1978-170 <br />Ellison Pit <br />October 26, 2004 <br />NOV 0 5 2004 <br />Division ~f Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Delta <br />^, <br />1/n/V~Vh~~ <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 yeaz, 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 your revised written anneal re~nnrt and annual re~rf m ~n to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. ~l/ ~~ /7~ ~~ <br />Divisio~nFrecords indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Larry Record <br />Permittee Name: Delta County <br />Address: 501 Palmer St., Ste. 227 <br />Delta, CO 81416 <br />Phone Number: <br />Fax Number: <br />(970)874-2100 <br />(970)874-2114 <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 />CA / <br />tgna re Corporate Office ,Owner, or Designee <br />~ . l fo t /a , , , . , <. . .~~ <br />Date <br />M:~PERMI11MA57ERD000MENTSwf-AF-04 <br />