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4~ <br /> <br />PERMITTEE NAME: River Valley Rock, Inc. <br />PERMIT NO.: M-1977-522 MAR 1 2 2U04 <br />OPERATION NAME: Herman Feit Pit <br />Division of Minorels end Geology <br />ANNIVERSARY DATE: March 23, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />According to C.R.S. 34-32.5-1 ]b 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 current disturbances to affected land, <br />~- rec--7amation accomplCs a to ate and curing-the preceding y'dat;-new-distarhan~:.s tr,at~:~anti~ip~tod to odour <br />during the upcoming yeaz, 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 ynnr revised written anneal rennrt and anneal report man to Chic form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Al Lunbery <br />Pennittee Name: River Valley Rock, Inc. <br />Address: P. O. Box 967 <br />Greeley, CO 80632 <br />Phone Number: (303) 353-9939 <br />Fax Number: <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 />Signature of Corporate Of tcer, Owner, or Designee <br />-D <br />Date <br />