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~~ ~ /L <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Nikolaus Arnusch <br />M-1981-287 <br />Arnusch Grav Pit 3 <br />February 25, 2004 <br /> <br />RECEIVE® <br />FEB 18 2004 <br />Diuisian of Minerals & Geology <br />$281.00 (Due on or before your anniversary date) <br />Weld <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 />seal s t-the~nnnal- fee,,-a-report-and--map-showing-the_extenLo£_cunent_distuibances 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 ymlr revised written annual rennrt and annnal rennrt m ~n to this form- Please no[e 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: Nik Arnusch <br />Permittee Name: Nikolaus Arnusch <br />Address: 34527 WCR 6 <br />Keenesburg, CO 80643 <br />Phone Number: (303) 732-4427 <br />Fax Number: <br /> ~~ <br />JJ <br />~ \1 ~~ <br />~~ } <br />n ~.: <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. Annual Report instructions are enclosed. <br />Srgnature of orporate Officer, Owner, or Designee <br />~~~ ~ y ~~ <br />Date <br />M:\PERMIT\MASTERIK)CUMENTS4M-AF-01 <br />