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<br /> ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Otero County (Engineering) <br />„ ~. <br />~~~~~~~~ <br />PERMIT NO.: M-1978-267 SEP 16 2004 <br />OPERATION NAME: <br />ANNIVERSARY DATE: Argo Gravel Pit <br />August 26, 2004 Division o/Minerals and Geology <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Otero <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 />-cpcrator-shall-submit-the-arnual fee,-a-report and map showing-the-extent of current- disturba^.ces-±o at!Fected <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 your revised written annual report and annual report 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 report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Kenneth S. Parker <br />Permittee Name: Otero County (Engineering) <br />Address: P.O. Box 511 <br />La Junta, CO 81050 <br />Phone Number: (719) 383-3035 <br />Fax Number: (719) 383-3935 <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 instmctions are enclosed. <br />~ P~t~-, <br />Signature of Corporate Officer or Owner <br />Dam <br />