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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Western Mobile Southern, Inc. <br />M-2002-009 <br />Beeman Pit #I <br />May 20, 2003 <br />RECEIVED <br />Jl1N f 0 2Q03 <br />Division ~f Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Pueblo <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 operator <br />shall'snbmit-the annual fee,-a report-and'map showing the eztenf of current disturbances"to affected land; <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anmial rennrt and annual re~prf maw to this form. Please note That an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Eric Reckentine <br />Permittee Name: Western Mobile Southern, Inc. <br />Address: 1590 W. 12th Ave. <br />Phone Number: <br />Fax Number: <br />Denver, CO 80204 <br />(303)657-4330 <br />(303)665-7433 <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 enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:\PERM ITNIASTERDOCUMENTSUI-AF-01 <br />