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r 's <br />?K <br />AL FEE and PORT REQUEST m .? r <br />K- <br />PERMITTEE NAME: /'Green Brothers, Inc. <br />UL ®9 2008 <br />PERMIT NO.: /M-1995-030 ' so' car ie(e?' ailon' <br />OPERATION NAME: Green Bros Pit No 2 ?1nin9 and ?a;e1y <br />ANNIVERSARY DATE: July 7, 2008 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Morgan <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 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 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 />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map 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: r. <br />Permittee Name: Green Brothers, Inc. kle_ A >F'_? <br />Address: 19441 Highway 34 2zo "Id- <br />P.O. Box 858 ??? x io 0 <br />Fort Morgan, CO 80701 ?erlin ce Z:D e3 "sl <br />Phone Number: (970) 867-2404 -70 <br />Fax Number: (970) 867-2405 5 ??M - -52 Z - 7:. <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 />Signature of Corporate Officer, Owner, or Designee <br />Date