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999 RECEIVED <br /> AUG 2 12001 <br /> ANNUAL FEE and REPORT REQUEST <br /> Division of Minerals and GeologY <br /> PERMITTEE NAME: Western Mobile Northern, Inc. <br /> PERMIT NO.: M-1979-191 <br /> OPERATION NAME: Three Bells Pit <br /> ANNIVERSARY DATE: August 15, 2001 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Larimer <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, each year, on the anniversary date of the permit, an operator <br /> shall subnut 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 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 report and annual report man to this form. Please note that an <br /> adequately labeled map that dearly 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: Eric Reckentine <br /> Permittee Name: Westem Mobile Northern, Inc. <br /> Address: 1590 W. 12th Ave. <br /> Denver,CO 80204 <br /> Phone Number: (303) 657-4330 <br /> Fax Number: (303) 657-4339 <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 /> S' nature Corporate Officer or Owner <br /> ` /3/D/ <br /> Date <br /> M APERMHWASTERDOCUMENTRM AF-01 <br />