REP50826

• Permit No: M1980149
• IBM Index Class Name: Report
• Doc Date: 2/22/2002
• Doc Name: 2002 Annual Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMTTTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE;
ANNUAL FEE DUE:
COUNTY:
Weld County
M-1980-149
Hokestra Pit No 1
March 1, 2002
RECEIVED
FEB 2 212
Division of Minerals and Geolagp
$688.00 (Due on or before your anniversary date)
Weld
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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
_ land,, reclamation accomplished to date and during t_he 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 vour revised written annual report and annual report map to this form. Please note than an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following petmittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Greg Nelson
Permittee Name: Weld County
Address: P.O. Box 758
1111 H St.
Greeley, CO 80632
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 i[ to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature ~ Cor/porate Officer or Owner
-~Z ~/ z In .2
Dale
ANNUAL FEE and REPORT REQUEST
M:IPERMITRIASTERD000MEMSIM-AF W