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- ~ ~ • • III IIIIIIIIIIIIIIII <br />ANNUAL REPORT <br />PERMITTEE NAME: Custer County <br />PERMIT NO.: M-95-026 <br />OPERATION NAME: Gravel Pit M-093* <br />ANNNERSARY DATE: August 24, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUNTY: Custer <br />1® .~-:~ <br />JUI. U ti 1999 <br />Division of Minerals $ GCGIO9y <br />According to C.R.S. 34-32-116(3)(a), 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 <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />annual report. Please note that an adequately labeled map that clearly delineates and <br />includes the above elements mny suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: Gary Havens Com an Custer County Road S. Bridge <br />P Y~ <br />Address: 213 N. 4th Street Phone No.: (719 ) 783-2281 <br />P.0. Box 239 Fax No.: ( 719 ) 783-0391 <br />Westcliffe, CO 81252 <br />If there are additional comments and/or information that should be provided to the Division, <br />please pro it on a_s~par a sheet and attach it to [his report form along with your map and/or <br />writte o v(/~ <br />GARY HAVENS ROAD SUPERVISOR <br />Signature of Corporate Officer, or Owner <br />6/14/99 <br />Date <br />INSTRUCTIONS ON BACK <br />