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_~ <br />i <br />~ III IIIIIIIIIIIII III ~ - ~ =~`~ <br />ANNUAL REPORT <br />PERMITTEE NAME: Mobile Premix Inc <br />PERMIT NO.: M-82-147 , <br />~ a~~.. <br />OPERATION NAME: Nyholt Pit <br />ANNIVERSARY DATE: September 03, 1999 <br />ANNUAL FEE DUE ON A]YNIVERSARY DATE: $550.00 <br />COUNTY: Adams <br />According to C.R.S. 34-32-116(3)(a), 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 <br />to affected land, reclamation accomplished to date and during the preceding yeaz, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming; yeaz, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual resort maa and written resort to this <br />annual report. Please note tftat nn adequately labeled Wrap that clearly delineates and <br />includes the above elements may suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />('gable ~r,tclti~Y (o-t^u~{-2 <br />Contact Name: ~r~ ~ ~a~lc~{-.^Q Company: ~ L. .c C ~~• <br />Address: ~<<~~~~.-~ Syv~t~5 PhoneNo.:(303 )6S}-5/'33a <br /> <br />~~~ u ~o ~aoY <br />Fax No.: (~03) d's}- y3.z~ <br />If there are additional cotmnen[s and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it to this report form along with your map and/or <br />written report. <br />9lcz/~/9 <br />Signature of Corporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />