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<br />ANNiiAi. FF,F, and REPORT RF,t1iiF,ST <br />PERMITTEE NAME: City of Cripple Creek RECE~ VED <br />PERMIT NO.: M-1993-039 JUL 2 9 2003 <br />OPERATION NAME: Midland Gravel Pit Division d Minerals and Geology <br />ANNIVERSARY DATE: August 4, 2003 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Teller <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 />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 your revised written annual rennrt and anneal rennrt m ~n 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: Chip Huffman <br />Permittee Name: City of Cripple Creek <br />Address: 207 County Rd. 89 <br />P.O. Box 430 <br />Cripple Creek, CO 80813 <br />Phone Number: <br />(719)689-2125 <br />Fax Number: <br />(719)689-0121 <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 />Signatu of Corpo e Officer, Owner, or Designee <br />a~- as-o,~ <br />Date <br />M:~PERMnVNASTERD000MENTSVd-AFA4 <br />