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999 <br /> ANNUAL FEE and REPORT REQUEST RECEIVED <br /> DEC 0 5 2000 <br /> PERMITTEE NAME: Western Mobile Northern, Inc, <br /> Division of Minerals and Geafaplt <br /> PERMIT NO.: , wlq"-131 <br /> OPERATION NAME: Bunn Ranch Pit <br /> ANNIVERSARY DATE: November 15,2000 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Moffat <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 attach your revised written annual report and annual report map 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 Eric Reckentine <br /> Permittee Name: Western Mobile Northern, Inc. <br /> Address: 1590 W. 12th Ave. <br /> Denver, CO 80204 <br /> Phone Number: (303) 657-4330 <br /> Fax Number: (303) 657-4339 <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 /> Signature of Corporate Officer or Owner <br /> Date <br /> MAPERMITMASTERDOCUMENTSW-AF 01 <br />