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• ~F~- ~ <br />ANNUAL FEE and REPORT REQUEST <br />~?"~f"''?'"Pq OP°~ <br />PERMITTEE NAME: mill Kobobel <br />PERMIT NO.: ~I-1991-123 ~~~ ~ 4 Z~~~ <br />lion of Reclamation, <br />OPERATION NAME: Idaho Creek Resource pgjuing ~~ g <br />ANNIVERSARY DATE: March 10, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COIIN"I'Y: 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 operator <br />-shall-submit the -annual-fee,,-a report-and- map showing- the-extent- of-cursent-disturbances-to affected land; <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to 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 the year, if any. <br />Please attach vour revised written annual resort and annual report man to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous vear and no new chances to <br />the urevious year's man are necessary, then no new maa is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may 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: Bill Kobobel <br />Permittee Name: Bill Kobobel <br />Address: 7909 WCR 5 <br />Longmont, CO 80504 <br />Phone Number: (303) 772-6916 <br />Fax Number: (303) 494-0770 <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 enclosed. <br />~ ~ ~ ~~~ <br />S' ature of or`por~ate Officer, O per, or Designe <br />f~(..I 1 <br />rl~ra <br />