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. '`ti_ <br />`2 <br />.~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~ ~- R~T- <br />ANNUAL FEE and REPORT REQUEST <br />City of Greeley <br />M-2002-020 V <br />25th Avenue Site <br />May 30, 2008 <br />~~~r <br />MAY 0 7 2008 ~/ <br />L3ivisinn o7 ~eciamstion, ~ <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Weld <br />_ ___ According to C.R.S._34-3.2.5_-116 or C.R.S. 34-32-116 each year, on the anniversary date of the permit, an _ _ _ <br />-- - -'--- <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 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 chances 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: .Seams <br />Permittee Name: City of Greeley <br />Address: 1100 10th St., Suite 300 <br />Greeley, CO 80631 <br />Phone Number: {~A}-3~-483,9 <br />Fax Number: (970) 350-9805 <br />~~~~'~i1NG ~~~i~GrL~ <br />9'ID 3So 9 S'6~ <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 />'gnature o Co e Off r, Owne , or Designee <br />~9 <br />Date <br />M:~PERMIT~MASTERDOCUMENTS~IvI-AF-04 <br />