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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />ANNUAL FEE and REPORT REQUEST <br />weld County <br />M-1978-210 <br />Geisert Pit <br />March 1, 2001 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />RECEIVED <br />FEB 2 0100E <br />Division o(Minerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R,S. 34-32-116, each year, on [he 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 [o <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 resort and annual report map to this form. Please Wore thdt art <br />adequately labeled map that clearly delbreates and includes the above elements may suffice jor a wri[terr <br />report. <br />Division records indicate the following perntittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact Greg Nelson <br />Permittee Name: Weld County <br />Address: P.O. Box 758 <br />Greeley, CO 80632 <br />Phone Number: (970) 356-4000 <br />Fax Number: (970) 304-6497 <br />~< <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 />.v <br />Signatur of Corporate Officer or Owner <br />a/~~./~i <br />~ Date <br />M.~PE RM INIASTERDOC UPAENTSNA-AF-04 <br />