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lry~~l[~ <br />%~h~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ ANNTiAT, FF.F, and RRPORT RF.tITTF.ST <br />/ Weld County <br />/M-1980-149 <br />Hokestra Pit No 1 <br />March 1, 2006 <br />g~~C~1V~CD <br />i1AR 012006 <br />~edo9Y <br />Lp~mswn of M~netals end <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 />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal re~7nrt and annual re~nrf man to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: <br />Pennittee Name: <br />Address: <br />Greg Nelson <br />Weld County <br />1111 H St. <br />P.O. Box 758 <br />Greeley, CO 80632 <br />~K <br />Phone Number: (970) 356-4000 X970) 30y -(o~( 9~ '~ <br />Fax Number: (970) 304-6497 <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 />ignature Corporate Officer, Owner, or Designee <br />~l~l 1, <br />Date <br />M:~PERMITMAS7EADOCUMENTSNI-AF-04 <br />