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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Hardrock Sand and Gravel <br />M-1990-140 <br />Martin Pit 1-A <br />December 18, 2004 <br />c-~es <br />RECEIVED <br />FEB 012005 <br />Oivisian of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Moffat <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 />'^V'-reclamation-accomplished-to-date-and-during-the preceding-year,_new.disturbances_that_are.anticinated_to_occur _ __ <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written anmral report and annnal report mas to thic 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: Pat J. Weber <br />Permittee Name: Hardrock Sand and Gravel <br />Address: P.O. Box 141 <br />Phone Number: <br />Fax Number: <br />Craig, CO 81626 <br />(970) 824-4053 <br />(970)824-4053 <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 />gnat a of Corporate Officer, Owner, or Designee <br />!vo /tt/iii%u~G- ~c'7`~v~TeS ]`h~e ~,IZST- <br />y <br />Date <br />