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~, oi~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />RECEIVED <br />Weld County <br />/ FEB 2 0 2004 <br />M-1978-210 <br />Geisert Pit Division of Minerals & GoologY <br />March 1, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Weld <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land,-reclamation-accomplished-to~date-and.during_the preceding_year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the _ <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please atfarh ynar revised written annnal re~tnrt and annnal rennrt main to this form. Please note that an <br />adequately labeled map that clearly delineates and Includes the above elements may suffzce for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Greg Nelson <br />Permittee Name: Weld County <br />Address: P. O. Box 758 <br />Greeley, CO 80632 <br />Phone Number: (970) 356-4000 <br />Fax Number: (970) 304-6497 <br />k <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 <br />enclosed. <br />Si ature o orporate Officer, Owner, or Designee <br />a7/9fo~ <br />Date <br />M:IPERMITUfASTERDOCUMEMS~[.1-AF-04 <br />