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<br />PERnQITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />North Weld Gravel <br />M-1976-018 <br />North Weld Gravel <br />October 17, 2004 <br />~~. <br />R~CEIV E® <br />SEP15~ <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />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 I <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />~ --reclamation accom'plish`ed-to date and during tl5e-preceding year; new' disturoanees-that-are=antieipated_to occur _ . _ _ <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning I <br />j of active operations, and the date active operations ceased for the year, if any. <br />Pleaee attach y~rorr revicrd written annnal reQnrt and annnal re nn rt main to this form- Please note that an <br />adequately Inbeled 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: The map has not changed since last year, as no gravel was mined in 2004. <br />Permittee Contact: Leroy A. Bellmore <br />Permittee Name: North Weld Gravel <br />Address: 13480 WCR 100 <br />Nunn, CO 80648-9700 <br />Phone Number: (970) 897-2252 <br />'-_ --Fax_Number: -_ - -- - - <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 aze enclosed. <br />iature of o rate fficer, Owner, or esignee <br />~. <br />September 13, 2004 <br />Date <br />