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., <br />=„ <br />~` <br />G~tirt RIE~~'~~/~~~ <br />JAN 212006 <br />ANNTJAi. FF.F. and RF.PnRT RF.Oi F.ST G..,_ <br />- "'9r <br />PERMITTEE NAME: Northern Colorado Constructors, Inc. Aggregate Div <br />PERMIT NO.: M-2001-107 <br />OPERATION NAME: NCCI Pit #1 <br />ANNNERSARY DATE: February 27, 2006 <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_shoiving_the_extent occurrent 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 anmial rennrt and anneal rennrt m,~ to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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: Chris Zadel <br />Permittee Name: Northern Colorado Constructors, Inc. Aggregate Div <br />Address: 9075 WCR 10 <br />Ft. Lupton, CO 80621 <br />Phone Number: (303) 857-1754 <br />Fax Number: (303) 857-2933 <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 />~+i~ <br />Signature of Corporate fficer, Owner, or Designee <br />I1261o6 <br />Date <br />