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ANNUAL FEIN and RE?ORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Glade, LLC <br />1,-2006-021 <br />Glade Quarry <br />January 4, 2009 <br /> <br />R? F!VED <br />AN 0 2 2009 <br />Division of Reclamation, <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Larimer <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 />recla`mahon accomplished to?ate and during the prece ing 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: Michael Bekkedahl <br />Permittee Name: Glade, LLC <br />Address: 1400 N Shields St <br />Fort Collins, CO 80524 <br />Phone Number: (970) 218-0282 <br />Fax Number: - ?o;m 42-0 , -J Q <br />l k Nc7 I-D Wcn2 &) <T <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with r written report and map. <br />Signa re of C orate Officer, wner, or Designee <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />Date