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~~ <br />ANNUAL FEE and REPORT REQUEST <br />OCT 1 52002 <br />., <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Western Mobile, Inc. <br />M-1979-002 <br />North Delta Pit <br />November 15, 2002 <br /> <br />RECEIVED <br />Dittision of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Delta <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 [o 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 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 reuort and annual reuort 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: Gary J. Tuttle <br />Permittee Name: Western Mobile, Inc. <br />Address: 1590 W. 12th Ave. <br /> Denver, CO 80204 <br />Phone Number: (303) 657-4123 <br />Fax Number: (303) 657-4339 <br />If you have additional comments and/or information that should be provided [o 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 />Signatur, of Co poste Officer, caner, or Designee <br />LG~ I n z <br />Date <br />M:~PERMITN~tASTERDOCl1MENTSU~7-AF-01 <br />