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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Kiowa County <br />M-1991-073 <br />Ferris Pit <br />July 12,2003 <br />$281.00 (Due on or before your anniversary date) <br />Cheyenne <br />RECEIVED <br />JUN 3 0 2003 <br />Division ~f Minerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 ]6, 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 precedingyear; new disturbances-thatare-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 />Pfeace attach ymn• revised written annual re~nrt and annnal rgpnrt mad to 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 />Permittee Contact: Rick Spady <br />Permittee Name: Kiowa County <br />Address: P.O. Box 100 <br />Eads, CO 81036 <br />---~" -`Phone Number: (719}438=5810---- <br />Fax Number: (719) 438-5327 <br />If you have additional comments and/or information that should be provided [o 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 gnature of Corp ate Offi ,Owner, or Designee <br />I0- ~2,f--03 <br />Date <br />M:\PERM ITMASTERDOCUMENTS\M-AF-04 <br />