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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Otero County (Engineering) <br />M-1981-279 <br />Hancock Gravel Pit <br />February 1, 20C~ <br />$688.00 (Due on or before your anniversary date) <br />Otero <br />.pJ~ <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 swing tthe extent of current~isTirrbances 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 your revised written annual rennrt and anneal re nn rt 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 [Hake any necessary <br />changes: <br />Permittee Contact: Kenneth S. Parker <br />Permittee Name: Otero County (Engineering) <br />Address; P.O. Box 511 <br /> La Junta, CO 81050 <br />Phone Number: (719) 383-3035 <br />Fax Number: (719) 383-3935 <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 />M:~PERMI7IMASTERDOCUMENTSUI-AF-04 <br />