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r/ <br />R~~~~~~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Westhoff Farms <br />M-1987-166 <br />Westhoff Farms <br />December 1, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Morgan <br />NOV 2 52003 <br />Uiuision 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 />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 ynnr revised written anneal rennrt and anneal rennrt m =n fn this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffrce for a written report. <br />Division records indicate the following perinittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact Joseph E. Westhoff <br />Permittee Name: Westhoff Farms <br />Address: 2823 RD3 <br />Wiggins, CO 80654 <br />plione_N_t>_m1Ler: (990 483-5561 <br />Fax Number: (970) 483-5561 <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 />or Designee <br />Date <br />M:~PERMITUTASTERD000M ENTSVvt-AF-01 <br />