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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Alamosa County <br />M-2001-108 <br />Alamosa County Pit No. 1 <br />February 22, 2004 <br />RECEIVEp <br />FEB p p 2004 <br />Olviaion of Minerole & OaoloOY <br />$281.00 (Due on or before your anniversary date) <br />Conejos <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 snual 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 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 ynrn• revised written anmral report and anneal repprt man 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 />,, ~G7/Perinittee Contact:. Phil West- _ - <br />/ - <br />~~ermittee Name: Alamosa County <br />~/1~„/l~ddress: 8663 S. CR 109 <br />Alamosa, CO 81101 <br />:jam/ Yhone Number: <br />~~ax Number: <br />(719)589-6262 __ _ _ <br />(719)589-6063 <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 />Sigt~a rturtu e of Co orat Officer, Owner, or Designee <br />/ ~ ~ ~. ~ ~ , <br />Date <br />M: W ERN I'MIASTERDOCl1M EMSM-AF-04 <br />