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I<( S <br />A~ ~~~~ <br />RECEIVED <br />PERMITTEE NAME: North Weld Gravel ~ S 2 <br />PERMIT NO.: ~YI-1976-018 ~ Division of Minarala and Geology <br />OPERATION NAME: North Weld Gravel <br />ANNIVERSARY DATE: October 17, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />According to C.R.S. 34-32.5-116 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 wrrenf disturbances to affected land, - -" <br />reclamation accomplished to date and during [he 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 xqur revised written annnal report and anmral re~prt map to this 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: Enclosed is an updated map showing approximately 1 acre mined for 2005. <br />Permittee Contact: Leroy A. Bellmore <br />Permittee Name: North Weld Gravel <br />Address: 13480 WCR 100 <br />Nunn, CO 80648-9700 <br />Phone Number: (970) 897-2252 <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 />Signature of C~p~to O ref er, Owner, o~ D si~e- <br />September 16, 2005 <br />Date <br />