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~: <br />RECEIVED v <br />MAY 1 0 2~2 ~- <br />PERMPTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Las Animas County <br />M-1983-039 <br />Airport Gravel Pit <br />Apri128, 2002 <br />Qivision of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Las Animas <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 disfurtiances 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 vour revised written annual report and annual report map 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 [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Phil Dorenkamp <br />Permittee Name: Las Animas County <br />Address: -200•'-~ --~--T--~` , ^-~-~ <br />Trinidad, CO 81082 <br />Phone Number: (719) 846-4766 <br />Fax Number: (719) 846-0434 <br />~q~d ~~ G~,toiV.v//r/C~ <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 />~~ ~~~~ilzcyi <br />Signature of Corporate Officer Owner <br />/~~G Z <br />Date <br />M:~PERMITNIASTERDOCUMENTSU9-AF-01 <br />