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<br />1 <br />• <br />• <br />ANNUAL F <br />' III IIIIIIIIIIIII III )UEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rio Grande County <br />M-1987-019 <br />South Fork Pit <br />March 25, 2001 <br />FiECEIVE® <br />MAR 2 3 2001 <br /> <br />Division ai Minerals and Geology <br />$281.00 (Due ou or before your anniversary date) <br />Rio Grande <br />According [o C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on [he 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 aril during the preceding year, ue~v 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 />btdinning of active operations, and the date active operations ceased for the year, if any <br />Pleasr attach your revised written annual report and 'annual report map to this form. Please nose t/rat an <br />adequately labeled map that clearly delineates and includes the above elements mcry s:ffce for a written <br />report. <br />Division records indicate [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Lawrence "Buddy" Shaver <br />Permittee Name: Rio Grande County <br />Address: 168 N. Washington NOTE: We no loner have <br />P.O.Box46 a P. 0. Box. <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-4781 <br />Fax Number: (719) 852-0305 <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 />0~~4?e:rvGyLc~2.~ <br />Signature of Corporate Officer or Owner <br />3/moo/a~ <br />Date <br />\ M:~PERMI"I\MASTERDOCUh1ENTS~M-AF-Ol <br />