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1~ <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />I ~O <br />ANNUAL FEE and REPORT REQUEST <br />Western Mobile Southern, Inc. <br />M-1990-144 <br />Fillmore Pit <br />June 15, 2002 <br />RRDEl1/ED <br />JU,N p ~ X1101 <br />Division of Minerals and Geolo9Y <br />$688.00 (Due on or before your anniversary date) <br />Pueblo <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 <br />-sfiall sutimii 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 vour 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: Er[c Reckentine <br />Permittee Name: Western Mobile Southern, Inc. LA-r=R-i2LE cc~i , /.f/G• <br />Address: 1590 W. 12th Ave. <br />Denver, CO 80204 <br />Phone Number: (303) 657-4330 <br />Fax Number: (303) 657-4339 <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 />C~~-~s~~ <br />Signature of Corporate Officer or Owner <br />~~(Y/d Z <br />Date ~ -~ <br />M9PERMIT'N7ASTERD000MENTSVN-AF-01 <br />