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w? <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />AL FEE and REPORT REQUEST <br />Nielsons, Inc. <br />,I-1976-059 <br />Cortez Pit <br />June 17, 2008 <br />Vis <br />kAY 2 12008 <br />-? J?irGIJ iir r?E.C?dr ' <br />Wing and Saf on' <br />$$791.00 (Due on or before your anniversary date) <br />Montezuma <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-the--upcoming-y..ear.,_reel_amationjithat w-ill_be_performed during_the coming_y_ear, the dates for the_beginning_ <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 />may. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's may 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 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: Craig Wickstrom <br />Permittee Name: Nielsons, Inc.j°" <br />S u ? .K ? tL Gi? <br />Address: P.O. Box 1660 <br />22419 CR G <br />Cortez, CO 81321 <br />Phone Number: (970) 565-8461 <br />Fax Number: (970) 565-0188 <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 />Signa re of Corporate Officer, Owner, or Designee <br />/L <br />-) er <br />Date <br />s fc a'? y ?- GC s i¢ C/ V 7 1 ?/ G . do t dy IY4n. <br />.P,s.6 .