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PERMTTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />Mullett`s Excavating, L.L.C. <br />M-2000-115 <br />Mulletts Excavting Pit # 1 <br />January 29, 2003 <br />RE~EeVE® <br />JAN 2 4 2003 <br />UIViSian a/Minerals and Ceolag f <br />$688.00 (Due on or before your anniversary date) <br />Las Animas <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 />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished [o date and during the preceding year, new disturbances that are an[i'cipated 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,Qnr revised written annual re~nrt and annual fpi}ort maw to 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 ContacC Myron Mullett <br />Permittee Name: Muilett`s Excavating, L.L.C. <br />Address: P.O. Box 322 <br />Westcliffe, CO 81252-0322 <br />Phone Number: (719) 783-2056 <br />- - Fax Number: - - --(719)-783-0156 - - - - - - ' - _ _- - _ _ - _ _ _ , _ - _ <br />If you have additional comments andlor 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 enclosed. <br />Sigt a e of Corporate Officer, Owner, or Designee <br />/-2Q" D~ <br />Date <br />M:~PERMI'IW7 ASTERDOCUMECITSV`A-AF~01 <br />