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~• N p~ <br />RECEIVED <br />MAR 0 8 2004 <br />Division of Minerals & Geolonr <br />PERMITTEE NAME: •.Fantl K Holsinger ~~,,Q~x ~ ~~~ <br />PERMIT NO.: M-1980-052 <br />OPERATION NAME: Holsinger Gravel Pit <br />ANNNERSARY DATE: April 23, 2004 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Jackson <br />-According.to.C.R.S. 34-32.5-116~C.R.~ 3432-_116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current-disturbanoes to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to 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 xmrr revised written annual rem and anmrat report m fn this form. Please note that 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: Keith Holsinger <br />Permittee Name: .fiend K Holsinger <br />Address: P. O. Box 37 <br />Walden, CO 80480 <br />Phone Number: (970) 723-4587 <br />Fax Number: (970) 723-4771 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annua] Report instructions are enclosed. <br />r <br />Se ature of Corporate Officer, weer, or Designee <br />Dat~ <br />