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~. <br />ANNUAL FEE and REPORT REQUEST <br />I ~ <br />RECEIVED <br />JUL G 3 2ppp <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Western Mobile Southern, Inc. <br />M-1981-307 <br />Fountain Pit <br />June 15, 2002 <br />$688.00 (Due on or before your anniversary date) <br />EI Paso <br />Division of Minerals andCeology <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 [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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Peruuttee Contact: Eric Reckentine <br />Permittee Name: Western Mobile Southern, Inc. <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 />Signature of Corporate Officer or Owner <br />Date <br />M:~PERMITNIASTERDOCUMENTSU4-AF-01 <br />