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A~4 -R pT-- kl S ~' <br />l <br />ANNTiAT, FF.F. and RF.PfIRT RF.~~TT~'I'F`~S~"T,',,' <br />PERMTI"I'EE NAME: ~ Western Equipment & Truck, Inc. <br />PERMIT NO.: vM-2002-052 <br />OPERATION NAME: Two Rivers Rock <br />~~C~~~°°=~J <br />~UG 15 2005 <br />Division of 04irerais iy tiao'tof1V <br />ANNIVERSARY DATE: September 2, 2005 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />According to C.R.S. <br />shat] 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 ynnr revised written anneal re~nnrt and anm~al re nn rt maT M Chic form- Please note that an <br />adequately labeled nrap that clearly delineates and includes the above elements may suffice far a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Craig Sparrow <br />Permittee Name: Western Equipment & Truck, Inc. <br />Address: 2055 1st Ave. <br /> Greeley, CO 80631 <br />--- -Phene-Number:----(4-70)53-668- - -- <br />Fax Number: (970) 352-7315 <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 />Owner, or Designee <br />Date <br />