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~II ~I~~~II~~~~~~ ~~~ • RECEIVED <br />JIaN 0 3 200 <br />ANNUAL REPORT Division of Minerals & Geoio9Y <br />PERMITTEE NAME: Western Mobile, Inc. <br />PERMIT NO.: M-91-035 ~®~ ~" <br />OPERATION NAME: Bluestone Pit <br />ANNIVERSARY DATE: November 05,1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUNTY: Jefferson <br />According to C.R.S. 34-32.5-116(3)(a), 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 <br />land, reclaznation accomplished to date and during the preceding yeaz, new disturbances that are <br />anticipated to occur during the upcoming year, reclamation that will be performed during the coming <br />yeaz, the dates for the beginning of active operations, and the date active operations ceased for the year, <br />if any. <br />Please attach your revised annual resort man and written report to this annual resort. Please <br />note that an adequately labeled map that clearly delineates and includes the above elements may <br />since for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in [he space <br />provided: <br />Contact Natne: ~~ ` L ''fie ~~~ ~ ~C Company: ~`~ ~' ~N.1 f`'1 u b . LQ Zr\ c <br />Adddress: Is ~t~ ~' ~ ~-h ~ ~` Phone No.: (S'3) 65~ -cI?30 <br />~,~ o~•a :.~ L ~ ,YD ~' 1 Fax No.: (.3~3) d ~a- - `-/3 ~ o <br />If there are ;tdditional comments and/or information that should be provided to the Division, please <br />prouide it on a separate sheet and attach it to this report form along with your map and/or written <br />report. <br />C/ '~/~'/ <br />tl3loo <br />Signature of Corporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />