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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Weld County <br />M-19so-IZo <br />Koenig Pit <br />March 1, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />RECEIVED <br />FEB 15 2003 <br />Division vt Minerals and Geology <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 ^nnr revised written anneal re~nrt and anneal re ern t man 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Greg Nelson <br />Permittee Name: Weld County <br />Address: P.O. Box 758 <br />1111 H, St. <br />Greeley, CO 80632 <br />Phone Number: (970) 356-4000 <br />Fax Number: (970) 304-6497 <br />~i75c2 <br />If you have additional cornments 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 C orate Officer, Owner, or Designee <br />a/~,1~_~ <br />Date <br />M:~PERMITUTASTERDOCUMENTSVv1-AF-04 <br />