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J <br />~~G~PVE® <br />ANNi1Af. FF,F, and REPORT RF,OfIF.4T <br />DEC 0 21003 <br />PERMITTEE NAME: Bent County Division otMinerals and Geology <br />PERMIT NO.: M-1992-113 <br />OPERATION NAME: Verhoeff Pit No 2 <br />ANNIVERSARY DATE: December 17, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Bent <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 />aperator'shail'submit-the-annual-fec-a-report-andznap-showing7he ~tttent-af-currem-disturbances to ~ffected- <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 xQur revised written annual renr,rt and annnal rYnrt maw fn 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 />Petmittee Contact: Gary Pritchard <br />Permittee Name: Bent County <br />Address: P. O. Box 350 <br />Las Animas, CO 81054-0350 <br />Phone Number: (719) 456-2223 <br />Fax Number: (719) 456-0375 <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 /> <br />C Signaf~ ohf Corporate Officer, Owner, or Designee <br />Date <br />M iPERM INNASTERDOCUM ENTSVN-AF-04 <br />