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IIIIIIIIIIIIIIIIIII <br /> RECEIVED <br /> ANNUAL FEE and REPORT REQUEST OCT 2 2 2001 <br /> PERMITTEE NAME: Montezuma County Division of Minerals and Geology <br /> PERMIT NO.: M-1999-077 <br /> OPERATION NAME: Ormiston Gravel Pit <br /> ANNIVERSARY DATE: October 25, 2001 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Dolores <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, g'ae- W-A-P <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Pennittee Contact: Lloyd Everett <br /> Pennittee Name: Montezuma County <br /> Address: 1690 Hwy 145 <br /> Cortez,CO 91321 <br /> Phone Number: (970) 565-8666 <br /> Fax Number: (970) 565-9252 <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 /> Sinatu'?b o C//orporate Officer or Owner <br /> �o�9/oI <br /> Date <br /> M TERMriw1ASTERD0CUME.rrSVA-AF-04 <br />