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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Butala Construction Company <br />M-1987-127 <br />Butala Pit <br />May 11, 2002 <br />I '~ <br />RECEIVED <br />APR 2 9 2002 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Chaffee <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-lands ---- <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o 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 vour revised written annual report and annual report mau 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 Contact: Frank Butala - <br />Permittee Name: Butala Construction Company <br />Address: 7625 Hwy. 50 <br />Phone Number: <br />Fax Number: <br />Salida, CO 81201 <br />(719)539-2521 <br />(719)539-2523 <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 enclosed. <br />Signature of Corporate Officer or Owner <br />-l~e~ <br />Date <br />M:~PERMTMASTERD000MENTSVvI-AF-01 <br />