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~ (~ d~ <br />ANNiiAi, FF.F, and REPORT RF, iO IF,ST <br />PERMTTTEE NAME: Hall-Irwin Corporation ~~~a~~~~® <br />PERMIT NO.: M-2002-120 MAR? .~ ?OQy <br />OPERATION NAME: Bernhardt Resource ~iriai°°°JMineretsaadCeptOey <br />ANNIVERSARY DATE: April 15, 2004 <br />ANNUAL FEE DUE: $688,00 (Due on or before your anniversary date) <br />COUNTY; Weld <br />Q(~ ~~. <br />!~"" lr <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'dperator <br />shall 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-to-occur-- <br />during the upcoming year, reclamation that wilt be performed during the coming year, the dates far the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ym~r revised written annnal rem and annnal red nrf man to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffrce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contaot: <br />Permittee Name: <br />Address: <br />7eff Gregg <br />Hall-Irwin Corporation <br />3026 4th Ave. <br />P.O. Box 2150 <br />Greeley, CO 80631 <br />Phone Number: - (970) 352-6057 <br />Fax Number: (970) 352-6284 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below qr attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />ignatur ' of Co orate Offiber, Owner, or Designee <br />Date ' <br />