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999 <br /> ANNUAL FEE and REPORT REQUEST <br /> RECEIVED <br /> PERMITTEE NAME: Jake Kauffman & Sons, Inc. <br /> MAY 1 1 2001 <br /> PERMIT NO.: M-1978-327 <br /> OPERATION NAME: Kauffman Pit Division of Minerals and Geology <br /> ANNIVERSARY DATE: May 14,2001 <br /> ANNUAL FEE DUE: $550.00(Due on or before your anniversary date) <br /> COUNTY: Larimer <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 note that air <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: <br /> Perm ittee Contact Mary Kauffman <br /> Permittee Name: Jake Kauffman & Sons, Inc. <br /> Address: 808 SCR 9E <br /> Loveland, CO 80537 <br /> Phone Number: (970)667-1557 <br /> Fax Number: (970)667-9985 <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 /> Slg4/'r4 tu�f or'4 i�ms.� LiPLO � . <br /> na ate Offcerr o Or <br /> Date <br /> M\PERM IPMA STERDOCUNENTSW-AF-01 <br />