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~L~~:i`ry'd[~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Park County <br />M-1995-021 <br />Chaparral Pit <br />Apri124, 2006 <br />$281.00 (Due on or before your anniversary date) <br />Park <br />P1AR 2 '_ 2006 <br />Grvi~ion o(Mmerals and Geology <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 curnent disturbances to affected <br />--land; reclamatio^.-accomplished to date-and-during the p:eceding-year, new disturbances-that arc-anticipated~to - <br />occur during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ~ryir revised writtan nnm~al rennrt and annual re nn rf martn 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. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact David Kintz ~ ~~M ~ ~N~ <br />Permittee Name: Park County <br />Address: P.O. Box 147 <br />Fairplay, CO 80440 <br />Phone Number: (719) 836-}?.82' <br />Fax Number: (719) 836-4275 <br />~q ~3(n ~-f-Z~~ <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 />l <br />Signa re of orporate Officer, Owner, or Designee <br />~~i7 ~06 <br />Date <br />M:~PERMITNIASTERDOCUMENTSUv1-AP-04 <br />