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<br />,•~ "'RECEIVED <br />ANNUAL REPO <br />JUI_ ~'~ i9Sy <br />PERMITTEE NAME: Western Mobile Northern Inc. Division of Minerals 8 Geology <br />PERMIT NO.: M-77-098 <br />OPERATION NAME: Sievers Pit <br />ANNIVERSARY DATE: June 30, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUNTY: Garfield <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the perniit, an <br />operator shallsubmit the annual fee,.a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that are anticipated [o occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />annual report. Please note that an adequately labeled map that clearly delineates and <br />includes the above elements may suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: ~ric,~eC~:erl'~AY~Pr Company:V~eP.~em A/lob,~~~l-d~Gril~ <br />Address: 1590 Vv. IZ'~ eve. Phone No.: (303) (oS7' ~F33o <br />~enV PY r Cry. 8~717~1- - 3 ~-t l O Fax No.: (~3) la55 - 4339 <br />If there are additional comments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />Signa are of Corporate Officer, or Owner Date <br />/NSTRUCTIONS ON BACK <br />