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tl -ti?111111t`?l <br />999 <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: R M Diner Construction Co., Inc. <br />PERMIT NO.: M-1977-151 RECEIVED <br />OPERATION NAME: Greeley Pit JAN 3 0 2002 <br />ANNIVERSARY DATE: January 30, 2002 <br />Dtv?s+tte of Minerals and Geology <br />ANNUAL FEE DUE: $688.00 (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-accomptished-M-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 Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since 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: 2220 "0" St <br />Greeley, CO 80631 <br />Phone Number: (970) 356-2660 <br />Fax Number: (970) 256-2662 <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 /> <br />Signature of Corporate Officer or Owner <br />January 28, 2002 <br />Date <br />1 <br />P7 1PERAI IT1hl ASTER DOCUN I ENTSW-A F-01