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iii iiiiiiiiuiii iii <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />R M Hiner Construction Co., Inc. <br />M-1977-151 <br />Greeley Pit <br />RECEAVEp <br />JAN 3 0 2002 <br />~1,~ <br />January 30, 2002 Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 l6, 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-aecomptishedto-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 />ndequately Inbeled map that clenrly delineates and includes the above elements may since jor a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Con[ac[: Rex M. Hiner <br />Permittee Name: R M Hiner Construction Co., Inc. <br />Address: 2220 "O" St <br />Greeley, CO 80631 <br />Phone Number: (970) 356-2660 <br />Fax Number: (970) 256-2662 <br />If you have additional comments and/or information that should be provided [o [he Division, please provide i[ <br />below or attach i[ [o [his form along with your written report and map. Annual Report instructions are enclosed. <br />X61\ ~- ~IDVJ~, <br />Signature of Corporate Officer or Owner <br />January 28, 2002 <br />Dale <br />M IPERAtITU1ASTERD000~IENTSNI-AF~01 <br />