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:~ <br />~~~ <br />ANNiiAi, FFF, and RF.PnRT RF.niTFST <br />PERMITTEENAME ~Ni <br />l <br />I REC~' :~~~~® <br />: sons, <br />e <br />nc. <br />PERMIT NO.: !VI-1976-027 '"/~Y Z 4 2Q(~ <br />OPERATION NAME: Craig Pit /~ <br />v <br /> 0ivisioa of AMinerais and Gealvpp <br />ANNIVERSARY DATE: June 17, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <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 />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 ynnr revised written annnal red nrt and anmral rennrt mad 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: Craig Wickstrom <br />Perrnittee Name: <br />Address: <br />Nielsons, Inc. <br />22419 CR G <br />P.O. Box 1660 <br />Cortez, CO 81321 <br />Phone Number: (970) 565-8461 <br />Fax Number: (970) 565-0188 <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 />~~ ~ <br />Signature of orporate Officer, Owner, or Designee <br />S/a/o~ <br />Date ~ <br />