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czel't <br />ANNUAL FEE and REPORT REOIJEST <br />PERM1TTEF NAME: Western Equipment & Truck, Inc. <br />PERM IT NO.: A-2002-052 <br />OPERATION NAME: Two Rivera Ruck <br />ANNIVERSARY DA' E: September 2, 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. 34-32-1 l6, 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 pertartned 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 our 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 ehanues to <br />the previous veftr's map are necessary, then no new may is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled reap that clearly delineates and includes the <br />alcove 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 />Permitter Contact: Craig Sparrow <br /> <br />Permittee Name: Western EquiptT t & "truck, inc. <br />Address: 2055 1st Ave <br />Phone Number: <br />Fax Number: <br />Greeley, CO 80631 <br />(970) 353-6682 <br />(970)_352-7315 <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 />Signature of Corp ate (.) a er, Owner, ' esigneo <br />Date <br />5/5 d <br />5L£1Z5£016 << 90L8Z£8£0£ SM 92:£L 0L-40-LL02 <br />