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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Bill Kobobel <br />~M-1991-123 <br />Idaho Creek Resource <br />March 10, 2006 <br />~T~`~ <br />R~CE~~.lED <br />I~UL 2 6 2006 <br />r/nivieion al Minerals and Gealegy <br />$688.00 (Due on or before your anniversary date) <br />Weld <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 ourrent disturbances to affected <br />land, rcclamation accomplished-to•date and during-the-preced:'rg-ycar, new dis..:rba.:ces-that areantiaipated-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 vour 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 since for a written report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bill Kobobel <br />Permittee Name: Bill Kobobel <br />Address: 7909 WCR 5 <br />Longmont, CO 80504 <br />Phone Number: (303) 772-6916 <br />Fax Nan~uer. ~ -~ - - - - - - 7 2 0 - - .~/ q y _ a 7 Z d <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 />