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~~ ~~Q~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNiJAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Weld Count <br />Y <br />M-1978-210 !~ <br />Geisert Pit <br />March 1, 2008 <br />~~~ ~~t"f <br />FEB 2 6 2008 ,~/0 <br />Division of Reclamation, V <br />Mining and Safety <br />$$791.00 (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 />~~~ ~ cperator-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 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 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 map. If no new disturbances or reclamation have occurred during the previous vear 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: Greg Nelson <br />Permittee Name: Weld County <br />Address: P.O. Box 758 <br />1111 H St. <br />Greeley, CO 80632 <br />Phone Number: (970) 356-6496 <br />Fax Number: (970) 304-6497 <br />If you have additional comments and/or information that should be provided to the Division, pfease provide it <br />below or attac it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of C~-porate Officer, Owner, or Designee <br />~ ~~1m~ <br />Date <br />M: ~PERMITIMAS TERDOCUMENTSU~I-AF-04 <br />