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02i12i2002 06:31 KIRKLRND CONSTRUCTIDN -~ 17195370115 <br />-~ , <br />. i <br />ANNUAL FEE and REPORT REQUEST <br />1 PERMITTEE NAME: Midwestern Farms Resource <br />PERMIT NO.: M•1993-059 <br />OPERATSON NAME: Midwestern Forms <br />~ ANNIVERSARY DATE: March 4, 20112 <br />ANNUAL FE6 DUE: '5688.00 (Due on or bePorc your anniversary date) <br />COUNTY: Prowcrs <br />ND.255 D03 I ~- <br />RECEIVE® <br />FE6 2 51an1 <br />Diriaion of Minerals and GeoloBY <br />According to C.R-S. 34-32 5.1 ] 6 or C.R.S. 34.-32-116, each year, on the anniver$.uy dote of the permit, an operator <br />shall subnut the annual~iee, a report and map showing the extent of current disturbances to affected land. <br />- neelamatirin accomplished. to date and during the preceding year, new disturbance9-that ara-tntieipnted to oeeuF- .-_ -- - <br />during the upcoming year, reclamation rhar will be performed during the coming year, the dates For the beginning <br />of active operations, and the dste active operations ceased for the year, if any. <br />revised written annual report and onnnai report man to this form. Please pore rhnt nn <br />map thm clearly delineates and includes the aGave element, ntny safJicr jot a written report. <br />Division'records indicate the following perminee contact information. Please verify and make any necessary <br />changes: <br />Permit[ee Contact: ]amen H. Kirkland <br />Permittee Name: Midwestem Farms Resource <br />Address: P.O. Box 580 <br />Rye, CO 81069 <br />Phone Number: (719) 489-3385 <br />i-ax Number: (719) d89-?2b8 <br />If u have additional comment; and/or information rhar should be provided to the Division, please provide it <br />to or anach it ro this form along with your written re ort and map. Annual Report insnllc[ions are enclosed. <br />of Corporate <br />~~1~ <br />Dace <br />M:,PFAMrIWA$rEN UUCUMCP75VA~AF~01 <br />