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:4 ~ s~~7~ <br />ANNUAL FE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ Weld County <br />~M-1983-213 <br />Lehr Gravel Pit <br />March 1, 2007 <br />$$688.00 (Due on or before your anniversary date) <br />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 yeaz, 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 vour revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred during the previous vear and no <br />new chances to the previous year's man are necessary, then no new man is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since jor a written report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Greg Nelson <br />Permittee Name: Weld County <br />Address: 1111 H St <br />P.O. Box 758 <br />Greeley, CO 80632 <br />Phone Number: (470) 356-6496 <br />Fax Number: (970) 304-6497 <br />If you have addifional comments and/or information that should be provided to the Division, <br />below or atta h it to this form along with your written report and map. Annual Report <br />enclosed. <br />Signature of orporate Officer, Owner, or Designee <br />~,/~~ /~ <br />Date <br />--, , ,_,~ <br />DS ~'- .. . <br />~~ <br />please provide it <br />instructions are <br />nr:~rEanur~nsTeaoocun+Errrsvu-ne-oa <br />