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~'~n~~~ <br />RECEIVED <br />PERMTiTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Weld County <br />M-1980-149 / <br />Hokestra Pit No I <br />March 1, 2004 <br />FEB 2 0 2004 <br />Dluision of ~fi~terals & Gealapy <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 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•durirg-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 attaeh ynnr revised written annnat rrn_ort and anmral rennrt main to this form. Please note thaf an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Greg Nelson <br />Weld County <br />P.O. Box 758 <br />1111 H St. <br />Greeley, CO 80632 <br />(970)356-4000 <br />(970)304-6497 <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 />gnature of orporate Officer, Owner, or Designee <br />~~ /~~ <br />Date <br />M:WERMITMAS'IERIKICUMENfS7M-AF-04 <br />~l~. <br />