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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~ ~R~~ <br />ANNUAL FEE and R~EPfORT REQUEST <br />Westhoff Farms <br />M-1987-166 <br />Westhoff Farms <br />December 1, 2007 <br />~ - <br />,a,rn~4iQts;~, <br />Qivl~iS~ o~ a~~f~$,YJ <br />11~1n!ng. and. - - <br />$$323.00 (Due on or before your anniversary date) <br />Morgan <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 />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />-- during-tire-upeorning-year,-rectamatic3n-that wj-ll-be-performed-dur-ing-th®-coming year--the-datES -for-xhe-begiua~ing <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map 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 during the previous year and no new changes to <br />the previous year's map are necessary. then no new map 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 sufftce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joseph E. Westhoff <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax Number: <br />Westhoff Farms <br />2823 CR 3 <br />Wiggins, CO 80654 <br />(970) 483-5561 <br />(970) 483-5561 <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 enclosed. <br />Signature of Corpo to O icer, Owner, or Designee <br />Date <br />.5..~. ~"~ .a ~ <br />~ ~ ~~~ 1 ~ ~ <br /> <br />~'1 ~ y° ~~ <br />wits ~In,~ <br />