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<br />RECEIVED <br />AUG 1 4 2003 <br />PERMITTEE NAME: Prowers County <br />PERMIT NO.: M-1984-136 <br />OPERATION NAME: Brann Pit <br />ANNNERSARY DATE: August 31, 2003 <br />Division of Minerals and Geology <br />ANNUAL FEE DUE: $281.00 (Due ort or before your anniversary date) <br />COUNTY: Prowers <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 submri tthe annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal report and anneal report man to 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: Mark Dorenkamp <br />Permittee Name: Prowers County <br />Address: <br />Phone Number: <br />Fax Number: <br />109 E. Sherman St. <br />Lamar, CO 81052 <br />(719) 336-5536 -- -- - - - - -- - -- - -- - - -- - - <br />(719)336-9633 <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 />Signature of Corporate Officer, Owner, o estgnee <br />~~7 ~~ <br />Date <br />M:~PERMIiIMASTERD000MENTSU1-A F-Od <br />