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1 <br />PERMITTEE NAME: <br />PERMTI' NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ tVtr'Y/f.// <br />r ~ P / /// <br />ANNUAL F~E and REPORT REQUEST <br />/ Nielsons, Inc. <br />/M-1976-027 <br />Craig Pit ~ ~ ~ ~ i "[%u] <br />June 17, 2007 Divi:;o on, <br />(,.:mir_ _..~ ,,,.,~,y <br />$$688.00 (Due on or before your anniversary date) <br />La Plata <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_subm_it_ the annual f_ee, a- report -and map showine 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 />& Fee requirement is not met until we have received the following <br />The Annual Report <br />map. a no new a~smrpances or rec~amanon nave occurrea aurma the prev~ousweat~ana no new cnanaes to <br />the previous year's map are necessary, then no new map is required, provided thatthe Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map thaCClearly 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: Craig Wickstrom <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Nielsons, Inc. <br />22419 CR G <br />P.O. Box 1660 <br />Cortez, CO 81321 <br />(970)565-8461 <br />(970)565-0188 <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 />Signature of Corporate Officer, Owner, or Designee <br />.S ~ t O <br />Date <br />