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999 <br /> AUG 2 12001 <br /> ANNUAL FEE and REPORT REQUEST <br /> pivisian of Minerals and G60109Y <br /> PERMITTEE NAME: Western Mobile Northern, Inc. <br /> PERMIT NO.: M-1977-439 <br /> OPERATION NAME: Home Office Mine <br /> ANNIVERSARY DATE: August 15,2001 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Larimer <br /> According to C.R.S. 34-32.5-1 16 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 /> 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 your revised written annual report and annual report map to this form. Please note that an <br /> adequately labeled neap 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: Eric Reckentine <br /> Permittee Name: Western Mobile Northern, Inc. <br /> Address: 1590 W. 12th Ave. <br /> Denver, CO 80204 <br /> Phone Number: (303) 657-4330 <br /> Fax Number: (303) 6574339 <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 instruction: are enclosed. <br /> ignatur f Corporate Officer or Owner <br /> Date <br /> A7:1PERh11TWASTERDOCUMENTSW AF-01 <br />