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<br /> <br />at7 * RPT <br />ANNUAL FEE and REPORT REQUEST rQ <br />PERMITTEE NAME: Northern Colorado Constructors, Inc. Aggregate Div v <br />PERMIT NO.: M-2001-107 Owl <br />3 2??? 1 <br />OPERATION NAME: NCCI Pit #1 ?Ee 1ectaR`af?on, <br />ANNIVERSARY DATE: February 27, 2008 dSaleW <br />®00 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />- According-to-C-.R-S-34-32-5=-1-1-6-or-C-.R:S-3432=11-6; each-year,-on-the-anniversary-date-of-the-perrn t, ar,-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 the upcoming year, reclamation that will be performed during the coming year, 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 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 vear's map are necessarv. 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Chris Zadel <br />Permittee Name: Northern Colorado Constructors, Inc. Aggregate Div <br />Address: <br />Phone Number: <br />Fax Number: <br />9075 WCR 10 <br />Ft. Lupton, CO 80621 <br />(303) 857-1754 <br />(303) 857-2933 <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 f6rm along with your written reportand-map.-Annual Report-instructions-are-enclosed. -- <br />Signature of Corpora Officer, Owner, or Designee <br />Date