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emv/ <br />"` _ hMl~, ~hP~ <br />~r <br />.ti ' ~,~ <br />,~,UG ~ i 2005 <br />PERMITTEE NAME: Otero County <br />llivisia~ at I;?i::cra+= & G30io®Y <br />PERMIT NO.: M-2004-027 <br />OPERATION NAME: Mendenhall Pit <br />ANNNERSARY DATE: August 20, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Otero <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 and during the preceding yeaz, 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 ynnr revised written annnal rp,~rt and anm~al rennrt mad fn his 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 />Petmittee Contact: Kenneth S. Pazker <br />Permittee Name: <br />Address: <br />Otero County <br />13 W. 3rd St. <br />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 />uate <br />M:~PERMI"MIASTERDOC[JMEMSM-AP-04 <br />