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an <br />7~' <br />PERMITTEE NAME: City of Boulder RECEIVED <br />PERMITNO.: M-1977-393 JUN 05 20Q4 <br />OPERATION NAME: Jenkins Site <br /> Division of Mine*a!s?z.~~ <br />ANNNERSARY DATE: June 1, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before yo ur anniversary date) <br />COUNTY: Boulder <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 />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 ynnr revised written annnal re,~tnrt and annnal r n mgn to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Glenn Camere <br />Permittee Name: City of Boulder <br />Address: P.O. Box 791 <br />Boulder, CO 80306 <br />Phone Number: (303) 413-7623 <br />Fax Number: <br />303- 4`/3-76 17 <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 />Signature of Corporate Officer, Owner, or Designee <br />~ /~/~ v <br />Dat ~~- <br />M:~PERMI7Vv1ASTERDOCUMENTSU~I-AF-04 <br />