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Rpr_26 06 04:12p FREMOMT COUNTY 7192767321 <br />t•i ~ <br />/AAT!\"ii47, FF.F. and RF,PnRT RF,ni1F.ST <br />PERMITTEE NAiVIE: 'Fremont County <br />PERMIT NO.: ~'M-1994-092 <br />OPERATION NAME: Iron Mountain Road Gravel Pit <br />ANNIVERSARY DATE: January 23, 2005 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />P • 2 lrr~' <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 tee, a report and trap showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding yeaz, new disturbances that aze anticipated to <br />occur doting 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 Xgnr revicnd written ann .al re,Rprt and annnal re~nrt map t~ thic 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 the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Paul Garrett <br />Permittee Name: Fremont County <br />Address: Fremont County Commissioners <br />. 615 Macon Ave., Room #105 <br />Canon City, CO 8]212 <br />Phone Number: (719) 276-732() <br />Fax Number: (719) 275-?62(i <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 />l <br />~' ~2r ~; <br />Signature of Corp ate Officer, Owner, or Designee <br />Date <br />