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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Green Brothers, Inc. <br />M-1995-030 <br />Green Bros Pit No 2 <br />July 7,2003 <br />RECEEVED <br />_ JUN 2 3 2003 <br />Division ~t Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Morgan <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 [hat 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~m~r revised written anneal red nrt and anneal re,Fnrt main to this form- Please note that an <br />adequately labeled map that c/early delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jim F. Green <br />Permittee Name: Green Brothers, Inc. <br />Address: 19441 U.S. Hwy. 34 <br />P.O. Box 858 <br />Ft Morgan, CO 80701 <br />Phone Number: ~ (970) 867-2404 <br />_Fax Number:V - (970)-$67=2405- <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 />r <br />~-i~~. <br />Sig ature of Corporate tcer, Owner, or esignee <br />~~ /7-~ 3 <br />Date <br />M:~PERMITVNASTER DOCUMENTSU-I-AF-01 <br />