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• <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Total: <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br /> <br />III III III IIIIIII III • <br />Notice of Intent ~W .,.,-~ sss~~ ~~~~~~~ig Operations <br />11~ Annual Report ~->r~(~~~`7~_1_ <br />North Weld Gravel ti~G 7p i99h <br />M-76-O18 <br />NO/ 17/951 d Grave 1 * Divis,bq pl hmera,y s (;eo~uy <br />$550.00 (Due on your Anniversary Date) <br />a. Permitted acreage: 80 Acres b. County where mine is located: Weld <br />Has this mine been granted TEMPORARY CESSATION STATUS? YE5 NO <br />Does this mine operate MORE or LESS than 180 days per year? MORE LESS <br />Does this mine have a phased reclamation plan? YE~ NO <br />Total acres affected during the report year:* _ None <br />Total acres reclaimed for the report year:* _ None <br />Total acres in various stages of reclamation:* <br />a. Backfilled: None d. Topsoil replaced: ~~~ <br />b. Graded: None Average topsoil thickness <br />replaced: None <br />c. Seeded: None <br />List species seeded & seeding <br />rate for report year on back <br />The type and approximate quantity of fertilizers, organic material or soil <br />conditioners used for the report year:* None <br />8. Estimated total acres to be affected in the next report year:* Pfone <br /> <br />9. COMMENTS: This pit is worked less than 21 (twenty-one) days a year. <br />There is no increase in acres that have heen maned, cn rhP maw ,.,,~i.~ h~ti~ ~ame <br />as last year. <br />* Please show the location of the acreage for items 4 - 6 on your map**. <br />Indicate the phases of the reclamation which have been completed, correlated with <br />your timetable. <br />** NOTE: If there have not been any changes since the last annual repot and you <br />previously submitted a map which correctly depicts the current acreage in items 2 <br />through 6, then a new map is unnecessary. However, you must state this fact above. <br />'/i <br />Signature: ~fr~~', ~~1!~~ 1.,`._T~ Date: n,g„ter g~ look <br />Please type or print current contact name, mailing address, and phone number below: <br />Contact Name: LeRoy A. Bellmore ~ Phone: <br />Company: North Weld Gravel <br />Address: 13480 W.C.R. 100 <br />Nunn, CO 80648-9700 <br />i <br />970 ) 897-2252 <br />Federal Tax ID No. or Social Security No. <br />\~ <br />O <br />