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f~~~~7 <br /> <br />PERMITTEE NAME ANNUAL FEE and REPORT REQUEST <br />ll <br />I <br />C <br />ti <br />vH <br />i <br />: - <br />rw <br />n <br />orpora <br />on <br />a <br />PERMIT NO.: TM-1983-090 ~ 5 ZQQ~ <br /> <br />OPERATION NAME: <br />La Poudre Saud & Gravel Divis~ „~ of Reclamation, <br />wining and Safety <br />ANNIVERSARY DATE: January 17, 2007 <br />ANNUAL FEE DUE: $$688.00 (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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />rectamation-accomplished~to-date and-during the preceding'yeaz, new-disturbances that-are anticipated-[o occur~- <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual resort and annual resort maa to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee. report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the arevious year and no new chances to <br />the previous year's map are necessary. then no new man is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jeff Gregg <br />Permittee Name: Hall-Irwin Corporation <br />Address: 301 Centennial Dr. <br />Milliken, CO 80543 <br />Phone Number: (970) 587-7279 <br />Fax Number: (970) 587-7289 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature o o rate Officer, Owner, or Designee <br />---/ ~"/~ <br />Date ~-~ <br />