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~~s ~~'% <br />ANNUA FEE and R PORT REQUEST <br />PERMTI'TEE NAME: L.G. Everist, Inc. ,'~~; ^~ ~ ,~ <br />PERMIT NO.: ~-1999-120 ~ ~~~~~ <br />i <br />~~~~r <br />OPERATION NAME: Ft. Lupton Sand and Gravel Mine ~ . , ~ l~D~ <br />ANNNERSARY DATE: June I, 2007 ~-•:. ;: ^- ~;bn, <br />I.J ~i.i Vly <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: 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 operator <br />shall submit the annual fEe, a report and 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-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 your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the urevious year and no new chances to <br />the previous year's man are necessary. then no new map is required. urovided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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 />Permittee Contact: L Mayer Shults <br />~ <br />~i M <br />~-- <br />Permittee Name: yt <br />~„~I <br />L.G. Everist, Inc. <br />Address: 7321 E;. 88th Ave. Ste. 200 <br /> Henderson, CO 80640 <br />Phone Number: (303) 286-2247 <br />Fax Number: (303) 289-1348 <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 />`~ <br />v --~ <br />Signature Corporate O~r, O- wn~signe <br />~~s6~ <br />Date <br />