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P <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />[19 j.c, ( e ) I<- <br />ANNU L 4and' PORT REQUEST <br />P Flatiron Constructors, Inc. <br />✓1GI- 2006 -078 <br />Camenish Borrow <br />December 15, 2009 <br />$$504.00 (Due on or before your anniversary date) <br />Weld <br />J RECNIVED <br />NOV 2 4 2009 <br />DiyNgn of ReciamaUon <br />`ko Mining and Safety <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-accomplished-to 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 yewr; the dates 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: <br />Permittee Name: Flatiron Constructors, Inc. <br />Address: P.O. Box 2239 <br />Longmont, CO 80504 <br />Phone Number: (303) 485 -4050 <br />Fax Number: (303) 485 -7684 <br />If you have additional comments and /or information that should be <br />below or attach it to this form along with your written report and map. <br />ignature of Corporate Officer, Owner, or Designee <br />Date <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />