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.a <br />0 <br />N <br />~- m <br />ANNUAL FEE and REPORT REQUEST ~ Z C7 <br />-- m <br />o C <br />PERMITTEE NAME: Hall-Irwin Corporation d g m <br />PERMIT NO.: M-1996-060 chi c.~ 0 <br />0 <br />OPERATION NAME: Firestien Pit m <br />ANNNERSARY DATE: December 31, 2002 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: 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 operator <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 [hat are anticipated to 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 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 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: ~' <br />Permittee Name: Hall-Irwin Corporation <br />Address: P.O. Box 519 <br />Greeley, CO 80632 <br />Phone Number: (970) 352-6057 <br />Fax Number: <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 />Owner, or Designee <br />~~i -Ti/ ~ ~7i <br />Date <br />M iPERM17 VNASTERDOCUMENTSVvI-AF-01 <br />