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T <br />PERMTI'TEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />L. G. Everist, Inc. <br />M-1999-120 <br />Ft. Lupton Sand and Gravel Mine <br />June 1, 2002 <br />RECEIVED <br />JUN 0 4 2002 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />According to C.R.S. 34-32.5-] 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall'subnuY'the~anunat`fee-a-report"and'map=shawnig-th2-extcnt-of-current-disturbances-to-affected land; <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: '~- <br />Permittee Contact: Lynn Mayer <br />Petmittee Name: L. G. Everist, Inc. <br />Address: <br />Phone Number: <br />Fax Number: <br />7321 E. 88th Ave. Ste. 200 <br />Henderson, CO 80640 <br />(303)287-4656 <br />(303) 2~~8Q~i ~ <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 enclosed. <br />Stgna[ure o Corporate Officer or Owner <br />s~ 3r-o2. <br />Date <br />M:~PERMINNASTERDOCUMENTSU-I-AF-01 <br />~ 0.3 -z g~- ~<35~R <br />