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<br />0/c <br />V <br />ANNALFFEanJeEPORT REQUEST <br />m.? <br />RECEIVED <br />PERM ITTEE NAME: " M Hiner Construction Co Inc 4. <br />PERMIT NO.: 2MI-1977-151 N 2 2 2009 <br />OPERATION NAME: Greeley Pit Division of Reclamation, <br />-? V Mining and Safety <br />ANNIVERSARY DATE: January 30, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: 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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation -aecomplished-to=dat---and- dur-ingAlie_preceding -year, new isturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the-begin-ning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 durin the previous year and no new changes to <br />the previous year's map are necessary, then no new previous year's map are then no new mais reuiredrovided that the Oerator shall state required, that the Oerator 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: Rex M. Hiner <br />Permittee Name: R M Hiner Construction Co Inc <br />Address: 11 Austin Rd <br />Lamar, CO 81052-4301 <br />Phone Number: (719) 336-3467 <br />Fax Number: (719) 336-5031 <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 />jjw?-? Oc-?Q Ll-X <br />Signature of Corporate Officer, Owner, or Designee <br />Zv LW <br />Date