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iiiiiiiiiii , <br /> ANNUAL FEE and REPORT REQUEST R <br /> FcF��F <br /> PERMITTEE NAME: Mike A Ferrero MQj' 0 <br /> PERMIT NO.: M-2000-028 <br /> OPERATION NAME: Ferrero Pit an <br /> ara/s <br /> ANNIVERSARY DATE: April 26,2001 �Caa/ogy <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: Huerfano <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 your revised written annual report and annual report map 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. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Mike A. Ferrero <br /> Permittee Name: Mike A Ferrero <br /> Address: 34259 Hwy. 12 <br /> Trinidad, CO 81082 <br /> Phone Number: (719) 846-2176 <br /> Fax Number: (719) 846-7512 <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 /> 04 <br /> S gnature of Corporate Officer or Owner <br /> �-/ -,;,2 � <br /> Date <br /> M'�PERMITWA.STERDOCUMENTSNM-AF-01 <br />