2001-11-21_REPORT - M1980131

• Permit No: M1980131
• IBM Index Class Name: Report
• Doc Date: 11/21/2001
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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999
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REQUEST
Western Mobile Northern, Inc.
M-1980-131
Bunn Ranch Pit
November 15, 2001
$688.00 (Due on or before your anniversary date)
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According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-1 16, each year, on the anniversary date of the permit, an operator
shall submit the annual fee, a repots and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and [he date active operation's ceased for the year, if any.
Please attach vour revised written annual report and annual report man to this Form. Please more that an
ndequnte[y labeled nrap rhnr clenr[y defineares aad inefudes the above e(emetus may st~ce jot a x~ritten repot[.
Division records indicate the following permi[tee contact information. Please verify and make any necessary
changes:
Permittee Contact: ~~@r[c'Re crtf'e
Permittee Name: Westem Mobile Northern, Inc.
Address: 1590 W. 12th Ave.
Denver. CO 80204
Phone Number: (303) 657330- ~/~~
Fax Number: [phone]
fo{~y ~(• n~E
IF you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this Form along with your written report and map. Annual Report instmctions are enclosed.
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Signat r for/p'orate Office or Owner
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