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<br />PERMITTEE NAME: Jake Kauffman & Son, Inc. RECEIVED <br />PERMIT NO.: M-1999-069 JAN 0 6 2003 <br />OPERATION NAME: Wagner/Kauffman Pit #3 <br />ANNIVERSARY DATE: January 5, 2003 Division of Minerals and Geology <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <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 />stiall`submirthe-annua',-fee-a-report-ard-map showing the-extent--of.-current_disturbances_to.affected_land,______ <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o 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 report and anm~al report m ~n fn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permit[ee Contact Mary Kauffman <br />Permittee Name: Jake Kauffman & Son, Inc. <br />Address: 808 SCR 9E <br /> Loveland, CO 80537 <br />Phone Number: (970) 667-1557 <br />Fax Number: (970) 667-9985 - <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 />Signatu of orp e Officer, weer, or Designee <br />D~ <br />M:~PERMI'IUTASTERD000M ENTSVvI-AF-01 <br />