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ANNUAL FEE and REPORT REQUEST RECEIVED <br /> PERMITTEE NAME: L. G.Everist,Inc. JUN 0 12001 <br /> PERMIT NO.: M-1999-120 Division of Minerals and Geology <br /> OPERATION NAME: Ft. Lupton Sand and Gravel Mine <br /> ANNIVERSARY DATE: June 1,2001 <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 <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning 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 rote that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: / J/ q 1 <br /> Permittee Contact: R' r� (mi l/�11V 141A JC f,— <br /> Permittee Name: L. G. Everist, Inc. C Y �bHPQ <br /> Address: 7321 E. 88th Ave. <br /> &Ire ZDb �- <br /> Henderson, CO 80640 <br /> Phone Number: (303)287-4656 / <br /> Fax Number: (303)287-8076 <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 <br /> enclo d <br /> ignatur o Corporate Officer or Owner <br /> Date <br /> M�PERMINAASTERDOCUAfENTSUMAF-01 <br />