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iP .,� � III I II I II I II IIII III <br /> sr ANNUAL REPORT T N V <br /> ® <br /> PERMITTEE NAME: Hall-Irwin Construction Co. RL� VED <br /> PERMIT NO.: M-84-099 <br /> OPERATION NAME: Bailey Pit <br /> Division of lriinerals✓£Geology <br /> ANNIVERSARY DATE: September 29, 1999 <br /> ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br /> COUNTY: Weld <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 !and, reclamation accomplished to date and daring 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 may 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: 1 II <br /> Contact Name: � ,.Vr Lrr"_51 Company: <br /> Address: _�)•O S I S Phone No.: ( L!)0 ) 3S 2 -(005 l <br /> �ce�P W Fax No.: ( Q7o ) _�S2- (02 ( <br /> If there are additional comments and/or information that should be provided to the Division, <br /> please provide it on a separate sheet and attach it to this report form along with your map and/or <br /> written report. <br /> Z� S <br /> Sig lure of o orate O r -r, or Owner Date <br /> INSTRUCTIONS ON BACK <br />