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ANNUAL FEE kdiORT REQUEST <br />PERMITTEE NAME: held County <br />PERMIT NO.: UM-1983-213 <br />OPERATION NAME: Lehr Gravel Pit <br />ANNIVERSARY DATE: March 1, 2009 <br /> <br />?,?1 D <br />PfEB 2 4 N,09 <br />ivi ?,44n ul ; ? d S f 4Y n, <br />70 Minim; <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />OA-' <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 vour 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 map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chanLyes to the previous vear's man are necessarv, 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) 356-6496 <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 />'4 - e ?! Zz -144, <br />Signature of rporate Officer, Owner, or Designee <br />??b9 <br />Date <br />M: TERMITU?4AS TERDOCLJMENTS\N4-AF-04 <br />0k