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ANNTTAT, FFF, and RFPORT RF.OTTRST ~1 <br />PERMITTEE NAME: L.G. Everist, Inc. ~EG~~1Z/~~ <br />PERMIT NO.: M-1999-120 JUN 012005 <br />OPERATION NAME: Ft. Lupton Sand and Gravel Mine ^ieicic:; of T;':,;,,.z~~ g, paotopy <br />ANNIVERSARY DATE: June I, 2005 <br />ANNUAL FEE DUE: 5688.00 (Due ou 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 y~r revised written anm~al reo~rt and anm~al renort mgp to this firm. Please note Lhat 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 />Permittee Contact: R. A Everist ~_ Y 11«1 /`~ \ /'~ ~1~_ <br />Permittee Name: L.G. Everist, Inc. <br />Address: 7321 E. 88th Ave. Ste. 200 <br />Henderson, CO 80640 <br />Phone Number: (303) 287-4656 --~Q~ _~b "-~, /yD7 <br />Fax Number: (303) 287-8076 .~J~'.3' Gam-!' ~c~70 <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 />ign a of Corpor e Off~r, Owner, esi ee ~y%~ <br />D ~!o ~OS- <br />Date <br />