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,; <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Nielsons, Inc. <br />M-1976-059 <br />Cortez Pit <br />June 17, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Montezuma <br />RECEIVED <br />MAY 2 0 2002 <br />Division of Minerals and Geology <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 ]and, <br />reclamation accomplished to date and during [he~receding_yeaz,_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 vour revised written annual report and annual report map to this form. Please note that an <br />adequately labeled neap that clearly delineates and includes the above elements may sufftce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Douglas L. Conger <br />Permittee Name: <br />Nielsons, Inc. <br />22419 CR G <br />P.O. Box 1660 <br />Cortez, CO 81321 <br />(970)565-8461 <br />(970)565-0188 <br />Address <br />Phone Number: <br />Fax Number: <br />c <br />NiPil3on5 .SSG^Ska Ti'c. <br />r <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 />Signature of Corporate Officer or Owner <br />3~// 7 ~n 2 <br />--~ <br />Dale <br />M SPERM mMASTERDOCUMENTSNI-AF-OI <br />