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• III IIIIIIIIIIIII III • <br />ANNUAL REPORT 1 ~ "~ <br />PERMI"fTEE NAME: Western Mobile Boulder, Inc. <br />PERMIT NO.: M-88-042 - ,~ fv iVED <br />OPERATION NAME: Cottonwood Pit <br />ANNIVERSARY DATE: October 12, 1999 ,,~e•a;~ &Gealogy <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUN7Y: Weld <br />According to C.R.S. 34-32-I 16(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 />disturbauces that are anticipated to occur during the upcoming year, reclamation that will be <br />perform<:d during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the yeaz, if any. <br />Please attach your revised annual report map and written report to this <br />annual repOCt. Please mote thut nn ndey«ntely labeled Wrap diet 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 />Wes~~., Mol-'te. a~.l~~,-t.,c. <br />Contact Name: ~r~c- ~,a,~ko.~~/~f.. Company: L~~.~lse ~u~i..~-~r.A-i <br />' t ~ ~t,n r~ ril LS. ~ <br />Address: ~ ~-- ~! ~ ~o ~ ~ t~ -1.e-rm~°.~- . Phone No.: (30.3) ~S~ - y33~ <br />-~90 G/ /a~~ A/C . Fax No.: (3D3) ~'~- ~~ <br />~~/.i CO 8o~a <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 />9 221°1 <br />Signature of Corporate Officer, or Own Date <br />INSTRUCTIONS ON BACK <br />