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•.. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Western Mobile Boulder, Inc. <br />M-1974-070 <br />Nelson Pit <br />February 15,2002 <br />1 b'- <br />RECEIVED <br />MAR 0 41002 <br />Divislon of Minerals and Geology <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 operator <br />shall 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 year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during [he coming year, the dates for the beginning <br />of active operations, and [he date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and anmral report map to this form. Please note that nn <br />adequately labeled map that clearly delineates and includes the above elements nary suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: Eric Reckentine <br />Permittee Name: Western Mobile Boulder, Inc... <br />Address: 1590 W. 12th Ave. <br /> Denver, CO 80204 <br />Phone Number: (303) 657-4330 <br />Fax Number: (303) 657-4339 <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 />~ ~~ <br />Signature of Corporate Officer or Owner <br />/~/6~ <br />Dat <br />M9PERMITNIASTERD000MENTSUI-AF-01 <br />