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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Ricky W. Mitchell <br />M-1990-131 <br />Mitchell Pit #2 <br />February 14,2003 <br />$281.00 (Due on or before your anniversary date) <br />Adams <br />RECEIVE® <br />FEB 142003 <br />Division of Minerals and Geology <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 operator <br />stfall submit-fhe an~nua fee, a repo an map showing the extent o c~dis-turbances fo affec[ed-land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annual rennrt and anneal r~pnrt maP to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ricky W. Mitchell <br />Permittee Name: Ricky W. Mitchell <br />Address: P.O. Box 10 <br /> Bennett, CO 80102 <br />Phone Number:' - =(303)644=4fi02 -- - --- - <br />Fax Number: <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 enclosed. <br />i~~2y /~~ <br />Signature of orporate Officer, Owner, or Designee <br />~ ~/ e/©3 <br />Date <br />M:~PERM ITMASTERDOCUMENTS~M-AF-01 <br />