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44 <br />WI Y <br />v ANN[iAT. FF:F. and RF.PnRT RF.OTiF.ST <br />TTEE NAME: <br />T NO.: <br />TION NAME: <br />ERSARY DATE: <br />~L FEE DUE: <br />t/ City of Greeley <br />~M-2002-020 <br />25th Avenue Site <br />May 30, 2006 <br />RECEr,~C <br />~APR?1~ <br />ion of Miner,i~ , ; ' <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />rding-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 - <br />tor shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />Wing of active operations, and the date active operations ceased for the year, if any. <br />eh vnnr revised written annual rennrt and annual report main to this form- Please note that an <br />labeled map that clearly delineates and includes the above elements may since for a written <br />records indicate the following permittee contact information. Please verify and make any necessary <br />Contact: Todd Williams <br />Name: City of Greeley <br />1100 10th St. <br />Cowl ~- `~- <br />' J...e .j0O t/ <br />Greeley, CO 80631 <br />If <br />e Number: (970) 350-9291 y~_ y l ~'~ O ` 33 b - ~{a3q ,, <br />Dumber: (970) 350-9805 <br />u have additional comments and/or information that should be provided to the Division, please provide it <br />v or attach it to this form along with your written report and map. Annual Report instructions are <br />Ca,-w~. <br />Officer, Owner, ar Designee <br />y (o ob <br />