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* � �� 81111111111111111111 � <br /> 999 <br /> ANNUAL REPORT 'P f QaAR f�aAAk <br /> uN6°'rV°, . �a 1�s <br /> PERMITTEE NAME: Farmers Bank of Brush <br /> PERMIT NO.: M-1980-135 RECEIVED <br /> OPERATION NAME: Headley Farms <br /> AUG 14 2000 <br /> ANNIVERSARY DATE: October 7, 2000 <br /> ANNUAL FEE DUE ON ANNIVERSARY DATE: $688.00 Division atllltttorsls mad GeologY <br /> COUNTY: Morgan <br /> I <br /> According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an operator shall <br /> submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br /> reclamation accomplished to date and during the preceding year, new disturbances that are anticipated <br /> to occur during the upcoming year, reclamation that will be performed during the coming year, the <br /> dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised annual report map and written report to this annual report. Please <br /> note that an adequately labeled Wrap that clearly delineates and includes the above elements may <br /> suffice for a written report. <br /> Please type or print the current contact person's name, mailing address, and phone number in the space <br /> provided: ,l� 1 /�r —�r <br /> Contact Name: UJJd�A� Qjean_ t�lW eowmpany. <br /> Address: WO'tUOL 16L n`M , a?-ke.rt e_. Phone No.: ( 1 <br /> ✓ Neeess�o� Ot Obera,+0V- FAX No.: <br /> � F ( ) <br /> aF711 - jo -- o0 e-mail: <br /> If there are additional comments and/or information that should be provided to the Division, please <br /> provide it on a separate sheet and attach it to this report form along with your map and/or written <br /> report. <br /> ✓ �- to oa <br /> Signature of Vrporate Offh er, or Owner Date <br /> INSTRUCTIONS ON BACK <br /> MAPER M FM ASTERDOC U MENTSM-AF-01 <br />