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~ N~ <br />AtytyTJAT. FF.F. and RF,Pt7RT RF.niJF.ST RECEIVE® <br />PERMITTEE NAME: N Colo Water Conservancy Dist JUL 0 £3 2004 <br />PERMIT NO.: M-1981-086 Division of Minerals & GeoloAY <br />OPERATION NAME: Borrow Area C <br />ANNIVERSARY DATE: July 21, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Grand <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 />--opeEate~s!?-sa . ..., .. . ~ r u anceb~o-affected _- _ <br />]and, 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 anmral rennrt and anneal report maP to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: N Colo Water Conservancy Dist <br />Jim Struble <br />Address: ~~ <br />220 Water Avenue <br />--L~eiar':<,z^v-ov639 Berthoud CO 80513 <br />Phone Number: (970) 532-7700 <br />Fax Number: --E9~Oj-663x6909- (970) 532-0942 <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 />enclosed. <br />;: <br />Si re of fficer, Owner, or Designee <br />~/O <br />Date <br />M:~PEAMITMASTERD000MENTSNI-AF-04 <br />