REP07792

• Permit No: M1987186
• IBM Index Class Name: Report
• Doc Date: 2/22/2002
• Doc Name: 2002 Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

4. ~
PERMITTEE NAME:
PERMTI' NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Weld County
M-1987-186
Peters Pit No 2
March 1, 2002
$688.00 (Due on or before your anniversary date)
Weld
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~, .<; ~ 2 2002
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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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
-land; reclamation accomplished to date and during the preceding-year,-new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report mau to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may. since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Gieg Nelson
Pertr>ittee Name: Weld County
Address: P.O. Box 758
Greeley, CO 80632
Phone Number: [phone] ~3 750
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature Corporate Officer or Owner
~~/a.~na
Date
M:V'ERMI'I V.IASTERDOCUMENTSVv1-AF-OC