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. • IIIIIIIIIIIIIIIIIII � ek# Irc7 \ � aBl eo <br /> ANNUAL FEE and REPORT REQUEST <br /> RECEIVED <br /> PERMITTEE NAME: Westhoff Farms DEC 0 4 2000 <br /> PERM IT NO.: M-1987-166 <br /> Division of Minerals and GeolopY <br /> OPERATION NAME: Westhoff Farms <br /> ANNIVERSARY DATE: December 1,2000 <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: Morgan <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. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact Joseph E. Westhoff <br /> Permittee Name: Westhoff Farms <br /> Address: 2823 RD3 <br /> Wiggins, CO 80654 'I <br /> Phone Number: (970)432-5561 71 Sy, <br /> Fax Number: (970) 432-5561 9 7 J " �{ �y ��Y 4 <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 /> t - l <br /> Signature of Corporate Officer or Owner <br /> II ) !� q� <br /> Date <br /> M.WERMMMASTERD000NIENTS .9-AF-01 <br />