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<br />ANNUAL FEE and REPORT REQUEST <br />DECEIVED <br />PERMI'TTEE NAME: Western Mobile, Inc. ~~U O s Z~2 <br />PERMIT NO.: M-1998-014 uivision of Minerals and Gei <br />OPERATION NAME: Gypsum Ranch Sand & Gravel Pit <br />ANNIVERSARY DATE: November 3, 2002 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Eagle <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of [he permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current distur_ba_nces to affected land, _ <br />reclamation accomplished [o 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Gary Tuttle <br />Permittee Name: Western Mobile, Inc. <br />Address: 1590 W. 12th Ave. <br />_ __ _ PhoneNumber: <br />Fax Number: <br />Denver, CO 80204 <br />(303)657-4123 <br />-x{3,39 <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/~ <br />Signature of Corp rate Officer, Ow er, or Designee <br />I I ~ ~~ 0~- <br />Dat <br />M:~PERMITMASTERD000M ENTSV.I-AF-01 <br />