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I <br /> 40 <br /> 999 <br /> ANNUAL REPORT PAID <br /> PERMITTEE NAME: Western Mobile, Inc. <br /> PERMIT NO.: M-1983-013 <br /> OPERATION NAME: Latham - Burkett Pit <br /> p° ( r. <br /> ANNIVERSARY DATE: April 28, 2000 c0�0 <br /> ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 '� Geology <br /> COUNTY: Mesa <br /> According to C.R.S. 34-32-I 16(3)(a), each year, on the anniversary date of the permit, an operator shall <br /> 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 <br /> to occur during the upcoming year, reclamation that will be performed during the coming year, the <br /> dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised annual report map and written report to this annual report. Please <br /> note that an adequately labeled map that clearly delineates and includes the above elements may <br /> suffice for a written report. <br /> Please type or print the current contact person's name, mailing address, and phone number in the space <br /> provided: <br /> Contact Name: EEtL QEGKEwtTltdE Company: UFkR-he <br /> Address: 1690 W . (V' k1E. Phone No.: 0 0 5 11059- - AISWO <br /> yGNVE2 co 00"-1 FAX No.: /aG?- - 4330I <br /> If there are additional comments and/or information that should be provided to the Division lease <br /> P � P <br /> provide it on a separate sheet and attach it to this report form along with your map and/or written <br /> report. <br /> Signature of Corporate Officer, or Owner Date <br /> INSTRUCTIONS ON BACK <br /> M:TER NI"I ASTER DOCU M EM'S W-AF-01 <br />