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~~ '~ i~ <br />ANNUAL FEE and REPORT REQUEST <br />1~ <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />JWestern Nutrients, Inc. <br />c/I14-1997-064 <br />Agri-Cal #1 <br />July 9, 2007 <br />JUN 2 8 2007 <br />Division of Reclamation, <br />Mining and Safety <br />$$225.00 (Due on or before your anniversary date) <br />Fremont <br />According tn.C.R.S.-34-32.5-1-16.or_G.R.S. 34-32-1-16,-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. 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 durinti the previous year and no <br />new chanties to the previous year's map are necessary, 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: Jerry Screws <br />Permittee Name: Western Nutrients, Inc. <br />Address: 6062 Umber St. <br />Arvada, CO 80403-7464 <br />Phone Number: (303) 422-9509 <br />Fax Number: (303) 423-0857 <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 />~J}GL~I~..o <br /><IG ~1- ~fi-tc.e~~ <br />Officer, Owner, or Designee <br />Date <br />MiPEAMn4NASTERD000MENTS/M-AF-02.DOC <br />