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h h~ <br /> 1/ANNi1Ai. FFF and RF.PnRT RF,(li1F.ST <br /> c~~v~° <br /> ~~ <br />PERMITTEE NAME: r/ Weld County ,~ ~Qp6 <br />PERMIT NO.: ~M-1978-210 o <br />~~ }~QR <br />Gep~ogy <br /> d <br />a~sa~ <br />OPERATION NAME: Geisert Pit otM~~e~ <br /> ~ ~~ <br />ANNIVERSARY DATE: March 1, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: 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 <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 />-- - -occurduring-the upcoming year, reclamaliori that will-be perform~auring 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~pnr revised written annual re~nrt and annual re~prt maw to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: Greg Nelson <br />Permittee Name: Weld County <br />Address: 1111 FI St. <br />P.O. Box 758 <br />Greeley, CO 80632 <br />Phone Number: (970) 356-4000 <br />Fax Number: (970) 304-6497 <br />~7o}.3ay-Gy4~ ~ <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 />Signature Corporate Officer, Owner, or Designee <br />~/~ 7 ~~l~ <br />Date <br />M:NERMI7IMASTERDOCUMENTSwi-AF-04 <br />