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999 <br /> ANNUAL FEE and REPORT REQUEST <br /> RECEIVED <br /> PERMITTEE NAME: Nikolaus Arnusch FEg 0 5 200, <br /> PERMIT NO.: M-1981-287 Division <br /> OPERATION NAME: Arnusch Grav Pit 3 °f NintralsandCeolo9Y <br /> ANNIVERSARY DATE: February 25,2001 <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Weld <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 <br /> operator shall submit the annual fee, a report and map showing the-extent-of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning 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 may to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following pennittee contact information. Please verify and make any necessary <br /> changes: �7 <br /> Perntittee Contact: Nik Arnusch <br /> PermitteeName: Nikolaus Arnusch <br /> Address: 34527 WCR 6 <br /> Keenesburg, CO 80643 <br /> Phone Number: (303) 732-4427 <br /> Fax Number: <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 <br /> enclosed. <br /> a'*� <br /> Signature <br /> of Corporate Officer or Owner <br /> es-c�> 2 Zvvi � <br /> Date <br /> M:\PERNUTUTASTERD000NIE NTSN-AF-01 <br />