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\ F cKA 0359 it 00 <br /> • ( s Z, 3�s _00) <br /> III IIIIIIIIIIIII III RECEIVED <br /> ANNUAL FEE and REPORT REQUEST <br /> DEC 2 6 20M <br /> PERMITTEE NAME: United Companies of Mesa County <br /> Division of Minerals and Geology <br /> PERMIT NO.: A&1990.K1 DENY <br /> OPERATION NAME: Virginia Acres OFF'C R <br /> ANNIVERSARY DATE: January 24,2001 E <br /> ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br /> COUNTY: Mesa <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 <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual report and annual report may to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Richard G. Johnson <br /> Permittee Name: United Companies of Mesa County <br /> Address: 2273 River Rd. <br /> Grand Junction, CO 81505 <br /> Phone Number: (970) 243-4900 <br /> Fax Number: (970)243-5945 <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 <br /> enclosed. <br /> 6�L <br /> Signature of Corporate Officer or Owner <br /> 124 z�/oy <br /> Date <br /> M TEP.NtmmAs"rEROOCUMENTSIM-AF-01 <br />