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.es~ ~~ j!~ ~ 5' <br />PERMTITEE NAME: <br />PERMIT NO.; <br />OPERATION NAME: <br />ANNP/ERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rio Blanco County ~Y` <br />,/M-2001-077 <br />Piceance Pit <br />August 28, 2005 <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 operator <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 X,ga~r revised written annual report and annual report man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ron Leeper <br />Pe~mittee Name: Rio Blanco County <br />Address: <br />Phone Number: <br />!~ - Fax Number: <br />570 Second St. <br />Meeker, CO 81641 <br />(970)878-5601 <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 farm along with your written report and map. Annual Report instructions are enclosed. <br />'IV+~~ ~+~~~ Gota.JM92 <br />Signature of Corporate Officer, Owner, or Designee <br />.-os' <br />Date <br />