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999 <br /> ANNUAL REPORT ®® <br /> PERMITTEE NAME: Western Mobile Northern Inc <br /> PERMIT NO.: M-77-184 , <br /> OPERATION NAME: Ft Collins Pit RECEIVED <br /> ANNIVERSARY DATE: October 30, 1999 3 1999 <br /> ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 Nov Z <br /> COUNTY: Larimer <br /> pivis�on of Mlnetals�Geolo9Y <br /> According to C.R.S. 34-32-116(3)(a), 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 <br /> to affected land, reclamation accomplished to date and during the preceding year, new <br /> disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br /> performed during the coming year, the dates for the beginning of active operations, and the date <br /> active operations ceased for the year, if any. <br /> Please attach your revised annual report map and written report to this <br /> annual report. Please note that an adequately labeled map that clearly delineates and <br /> includes the above elements may suffice for a written report. <br /> Please type or print the current contact person's name, mailing address, and phone number in the <br /> space provided: <br /> Contact Name: K P /4ef, �,e Company: /V,?i e,c A'e <br /> Address: /S- 5c' Z , i a f , /4 e Phone No.: (30 <br /> Fax No.: ( � ' ) 6S - c/37J <br /> If there are additional comments and/or information that should be provided to the Division, <br /> please provide it on a separate sheet and attach it to this report form along with your map and/or <br /> written report. <br /> Signature of Corporate Officer, or Owner Date <br /> INSTRUCTIONS ON BACK <br />