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+~~ ~ ~ ~~ <br /> ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Weld Count <br />y / <br />PERMIT NO.: M-1981-286 / <br />OPERATION NAME: Thomas Gravel Pit 4 <br />ANNIVERSARY DATE: March 1, 2008 <br />ANNiJAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />~~ <br />e 2 6240$ <br />Division of <br />Mining and Sa ~~ on, <br />~J' <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 fees 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 your revised written annual report and annual report man to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map 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 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: <br />Permittee Name: <br />Address <br />Phone Number: <br />Fax Number: <br />Greg Nelson <br />Weld County <br />1111 H St. <br />P.O. Box 758 <br />Greeley, CO 80632 <br />(970) 356-6496 <br />(970) 304-6497 <br />~~ <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 <br />enclosed <br />ignatur f Corporate Officer, Owner, or Designee <br />~~~51a~- <br />Date <br />M:~PERMITU~IASTERDOCUMENTS~A4-AF-04 <br />