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., <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />F /~-~ <br />ANNUAL FEE and/ REPORT REQUEST <br />~ City of Greeley <br />r/ M-2002-020 <br />25th Avenue Site <br />May 30, 2007 <br /> <br />~e~''1 `', 4 ~,~,~ <br />/f-~~ ,~ <br />~: ,~, <br />-~- ~, , <br />fviirin~ _nG-~-.aeripp. <br />SaPCty <br />$$688.00 (Due on or before your anniversary date) <br />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 <br />-~--_-operator_shall_submit-the-aunual.feP ~,re1Lrt and ma~chowing_the~e dent. 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 vour revised written annual report and annual report moo to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the previous year's moo are necessary. then no new moo is required. provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />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: Sean Cronin <br />Permittee Name: City of Greeley <br />Address: 1100 10th St. <br /> Suite 300 <br /> Greeley, CO 80631 <br />Phone Number: (970) 336-4039 <br />Fax Number: (970) 350-9805 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attac to this form along with your written report and map. Annual Report instructions are <br />enclosed./- ~ /"1 <br />Signature <br />i2 <br />Date <br />Owner, or Designee <br />M:~PERMIT~MASTERD000MENTSNI-AF-04 <br />