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r <br />RFG~1~~ <br />JAN Q 8 200 <br />Division of Mlnrtral8 i ®®®I®~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Northern Colorado Constructors, Inc. Aggregate Div <br />M-2001-107 <br />NCCI Pit #1 <br />February 27,2004 <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-atmual-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 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 your revised written anneal report and anneal re~nrt main 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: ~eerge-;?adcl- ~' .h c' ~ S z,rrle,i <br />Permittee Name: Northern Colorado Constructors, Inc. Aggregate Div <br />Address: 9075 WCR 10 <br />Ft. Lupton, CO 80621 <br />Phone Number: (303) $57-1754 <br />Fax Number: (303) 857-2933 <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 instmetions are enclosed. <br />I.YVIr~ f2.no~s~ ~fRYS"n~ <br />Signature o Corporate Officer, Owner, or Designee <br />~~ <br />Date <br />M:~PERMI"INSASTERDOCUMEN7SM-AF-0I <br />