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rlv, rc/ <br /> ~ ANNiiAi, FF.F, and REPORT RF. i~ CT <br />PERMITTEE NAME: ~ N Colo Water Conservancy Dist ~~~E~~J~D <br />PERMITNO.: I~M-1981-086 ~U~ ~ Q ~(~ <br />OPERATION NAME: Borrow Area C ~ <br />~~fan d Mi <br /> nerefs and Geglgs~ <br />ANNNERSARY DATE: July 21, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Grand <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 yeaz, 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 ym~r revised written annual report and annual rennrt man to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following pennittee contact infonnation. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jim Struble <br />Permittee Name: N Colo Water Conservancy Dist <br />Address: 220 Water Avenue <br /> Berthoud, CO 80513 <br />Phone-Number: (970) 532-7700 <br />Fax Number: (970) 532-0942 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />MIPERMITVNASTERDOCUMEMSNI-AF-04 <br />