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19 X19C <br />ANN AL FEE and REPORT REOUEST <br />PERMITTEE NAME: meld County <br />PERMIT NO.: ol(I-1980-149 FES 2 <br />OPERATION NAME: Hokestra <br />Division of °ac, <br />amation, <br />ANNIVERSARY DATE: March 1, 2009 'U Mining and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />0r/n- <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 <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 may. If no new disturbances or reclamation have occurred during the previous Year 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 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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Greg Nelson <br />Weld County <br />1111 H St. <br />P.O. Box 758 <br />Greeley, CO 80632 <br />(970) 356-4000 <br />(970) 304-6497 <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 />Signature o C orate Officer, Owner, or Designee <br />Date <br />M: TERMITIMAS TERDOCUMENTSW-AF-04 <br />