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999 <br /> RECEIVED <br /> ANNUAL FEE and REPORT REOUEST <br /> OCT 1 12001 <br /> PERMITTEE NAME: Nichols Gravel Pit, L.L.P. Division of Minerals and Geology <br /> PERMIT NO.: M-1981-013 <br /> OPERATION NAME: Nichols Gravel Pit <br /> ANNIVERSARY DATE: October 21,2001 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Mesa <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, each year, on the anniversary date of the permit, an operator <br /> shall submit the-annual fee, a report and map showing the extent of current disturbances-to affected--land, <br /> reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br /> during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br /> 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 an <br /> adequately labeled 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: <br /> Permittee Contact: John Nichols <br /> Permittee Name: Nichols Gravel Pit, L.L.P. <br /> Address: P.O. Box 285 <br /> Mesa, CO 81643 <br /> Phone Number: (970) 268-5525 <br /> Fax Number: (970) 268-5732 <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 enclosed. <br /> Si4fhature of Corporate Officer or Owner <br /> Date <br /> M PER M rrWASTERDOCUMENTSW-AP-01 <br />