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- , iiiiuiiiiiiiiuiii ~ <br />ANNUAL REPORT ®®® <br />PERMITTEE NAME: Western Mobile Northern Inc <br />PERMITNO.: M-77-036 RFC'~1~~1 <br />OPERATION NAME: Greeley Pit ~t~~~ 23 1SSg <br />39Y <br />~ u ~-- <br />ANNNERSARY DATE: October 18, 1999 ,,neta~ <br />pivis~on ei <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUNTY: Weld <br />According to C.R.S. 34-32-1 l6(3)(a), each year, on the anniversary date of the permit, an <br />operator shall submit the annual tee, a report and map showing the extent of current disturbances <br />to affected land, reclamation accomplished to date and during the preceding year, new <br />disturbances that are anticipated to occur during the upcoming year, reclamation that will be <br />performed during the coming year, the dates for the beginning of active operations, and the date <br />active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this <br />annual report. Please note that an udeytrately labeled ntnp that clearly delineates and <br />includes the above elements ntcry suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the <br />space provided: <br />Contact Name: - /- ~ '- /`~~ < Fi%,• ~•-e <br />Company: /~/*~~t~~ ~~5. L .i - <br />Address: /S`i u ~, iz f ~ o e <br />C.r, ,~ 7/ /1 ,~~~ 2 U `~ <br />Phone No.: (~o ~) C J 7 - ~/~ 70 <br />Fax No.: ( x 3 ) 6J' 7 - c/? <br />If there are additional cornments and/or information that should be provided to the Division, <br />please provide it on a separate sheet and attach it [o this report form along with your map and/or <br />written report. <br />7 <br />~ __ i//1?~i~ <br />{ / .-t l <br />Signature of Corporate Officer, or Owner Dale <br />INSTRUCTIONS ON BACK <br />