2001-11-13_REPORT - M1979002

• Permit No: M1979002
• IBM Index Class Name: Report
• Doc Date: 11/13/2001
• Doc Name: Annual Fee/Report Notice
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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999
ANNUAL FEE and REPORT REQUEST
RE'CE~VED
PERMITTEE NAME: Western Mobile, Inc.
PERMIT NO.: M-1979-002 NLIV ~ 3 2001
OPERATION NAME: North Delta Pit Uivisione'MineralsandG
eolopr
ANNNERSARY DATE: November 15, 2001
ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date)
COUNTY: Delta

According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-116, each year, on the anniversary date of the pernti[, an operator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual resort map to this form. I'lense more rirnr nn
odequare[v labeled map rhnt clearly delineates and incGrdes dte nbove elements may since for a n~ritten report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
G~ s. -rump
Permittee Contact: ruine
Permittee Name: Western Mobile, Inc.
Address: 1590 W. 12th Ave.
Denver, CO 80204
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Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instmctions are enclosed.
G{-
ySignatur f o orate Officer or Owner
/1~9~n/
Date
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