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~ : ~ iii iiiiiiiiiiiiiiu <br /> 999 <br />J <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Western Mobile Northern, [nc. <br />M-1981-088 <br />McCoy Aggregates <br />November 15, 2001 <br />$688.00 (Due on or before your anniversary date) <br />Routt <br />Y ~~~Ir~ n~ //~~ ~ V <br />NON 9 ~ i~~9 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of [he permit, an operator <br />shall submit the annual 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 [ha[ are anticipated [o 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 [he year, if any. <br />Please attach your revised written annual report and annual resort map to this form. Please note that ml <br />adequareh~ labeled map that clearly delineates mtd includes the above efemeuts play suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: ~--"~~......'~ ~.j ~ /~/ T- ~~~ <br />Permittee Name: Wes[em Mobile Northern, Inc. <br />Address: 1590 W. 12th Ave. <br />Denver, CO 80204 <br />Phone Number: (303) 657-4339' X y~Z3 <br />Fax Number: (303) 657-4339 <br />If you have additional comments and/or information that should be provided to [he Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature o C orate Officer or caner <br />~! 6 <br />Da e <br />AI IPERMrIN1ASTER DOCUAtEMSRLAF-01 <br />