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whe <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />AF~R?- <br />" M/ontezuma County <br />r/M-1999-077 <br />Ormiston Gravel Pit <br />October 25, 2005 <br />RE~E~"!E~ <br />~CT 1 q 2005 <br />Derision of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Dolores <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 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 annual report and annnal regprt mAn to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: Lloyd Everett <br />Permittee Name: Montezuma County <br />Address: 1680 Hwy. 145 <br />Phone Number: <br />Fax Number: <br />Cortez, CO 81321 <br />(970)565-8666 <br />(970)565-8252 <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 />S ature of orporate Officer, Owner, or Designee <br />~d/l/asp <br />Date <br />l~ C~ti.avla~. <br />M:~PERMIIIMASTERD000MEMSNI-AF-04 <br />