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~'~r <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />City of Greeley <br />M-2002-020 <br />25th Avenue Site <br />May 30, 2004 <br /> <br />RECEIVED <br />MAY 2 g 2x04 <br />Division o1 Minerals and Gao1o8Y <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 <br />_ _ _ __ __ operator shall submit the annual fee, a report and map showing_the~xtent_of current disturl~nc_es_to affected___ __ _ <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <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 vrnur revised written anmral report and anmral repDrt mao 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: Todd Williams <br />Permittee Name: City of Greeley <br />Address: <br />-- -Phone Number: <br />Fax Number: <br />1100 10th St. <br />Greeley, CO 80631 <br />(970}350-9291 <br />(970)350-9805 <br />:Src1 I~ ~On~ \'r`i C~~ <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 />(/~ ``%2i~~~ <br />~~ <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:NERMI71A7ASTERDOC[1MENTSV.r-AF-0O <br />