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d, <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Weld County <br />M-1980-121 <br />Pierce Pit <br />March 1, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />FiECEIVE® <br />FEB 2 5 2003 <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 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 />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 ymrr revised written anneal re; nrt and anneal re nrt man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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 n <br />Permittee Name: Weld County <br />Address: P.O. Box 758 <br /> 1111 H. S[ <br /> Greeley, CO 80632 <br />Phone Number: (970) 356-4000 ~ 7 7 _50 <br />Fax Number: (970) 304-6497 <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 />rgnature of rporate Officer, Owner, or Designee <br />~Z/~ I /a3 <br />Date <br />M:IPEAMITMASTERDOCUMENTSNI-AF-04 <br />