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~; _- <br />RECEIVE® <br />PERMITTEE NAME: <br />PERMIT NO.; <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bent County <br />M-2001-019 <br />Bent County Pit # 2 <br />June 22, 2005 <br />JUN i 3 2005 <br />Division of Minerals a~,,c Gealopq <br />$688.00 (Due on or before your anniversary date) <br />Bent <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 aril 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 xDnr revised written annual rennrt and annnal re~nrt main 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 the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Gary L. Pritchard <br />Permittee Name: <br />Address: <br />Bent County <br />P.O. Box 350 <br />Las Animas, CO 81054 <br />Phone Number: (719) 456-2223 <br />Fax Number: (719) 456-0375 <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 />Signature Corporate Officer, Owner, or Designee <br />J'u of ~ ~ ~oo.i <br />Date <br />M:~PERMITVdASTERDOCUMENTS~M-AF-04 <br />