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<br />• III IIIIIIIIIIIIIIII <br />sss <br />ANNUAL REPORT <br />PERMITTEE NAME: Western Mobile Northern, Inc. <br />PERMIT NO.: M-1979-191 <br />OPERATION NAME: Three Bells Pit <br />ANNNERSARY DATE: January 31, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $550.00 <br />COUNTY: Larimer <br /> <br />~-~~. <br />RECEIVED <br />JAN ~ i 2000 <br />QMIBIOn of Minerab ~ ueoiogy <br />According to C.R.S. 34-32-116(3)(a), each year, on [he anniversary date of the permit, an operator shall <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding yeaz, new disturbances that are anticipated <br />to occur during the upcoming year, reclamation that will be performed during the coming yeaz, the <br />dates for the beginning of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach your revised annual report map and written report to this annual resort. Please <br />note that an adequately [nbeled mnp thnt clearly delinentes and includes the above elements ntny <br />since jor a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: Fi~~L >? ~LI~N11 N~ Company: L~ ~a~ <br />Address: ~~J° /~' 6~ IZ~' ~'b Phone No.: ('~0 3) 4 h 7 -`{3'~u <br />Y CiV `+~l'Lk- Lu ~~U ~LC `i FAX No.:( '~c'3) ~h ~ ~ `f'~'~'i <br />If there aze additional comments and/or information that should be provided to the Division, please <br />provide it on a sepazate sheet and attach it to this report form along with your map and/or written <br />report. <br />~' /, <br />Signature of Corporate Officer, or Owner <br />~ ~ ~/Ud <br />Date <br />INSTRUCTIONS ON BACK <br />M ~PERMrIW1ASTERD000MENTSUI-AF-01 <br />