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N~6~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Weld County <br />M-1980-120 ~ <br />Koenig Pit <br />March 1, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />RECE11/ED <br />FEB 2 0 2004 <br />Division of Minerals & GaaloOti <br />According to C.R.S. 34-32.5-116 or C.R.5. 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-duringthe-upwming 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 re¢Q~and anm~al re~n~ ~ T 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 Contaet: Greg Nelson <br />Permittee Name: Weld County <br />Address: 1111 H. St. <br />P.O. Box 758 <br />Greeley, CO 80632 <br />Phone Number: (970) 356-4000 <br />Fax Number: (970) 304-6497 <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 />S gnature of rporate Officer, Owner, or Designee <br />~ ~9,,~~T <br />Date <br />M:IPERMIrIMASTERD000MENTSNr-AF-04 <br />