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- ~ ~ , , iii iuiuiiniu iii <br />ANNUAL REPORT <br />PERMITTEE NAME: Western Mobile Northern, Inc. <br />PERM]T NO.: M-1977-439 <br />OPERATION NAME: Home Office Mine <br />ANNNERSARY DATE: January 31, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $550.00 <br />COUNTY: Larimer <br />q•d~il/ <br />RI=CEIV~D <br />JAN :; i 2i7f1A <br />OiviSiottcl bSUiarafs 8 Geology <br />According [o C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, ati operator shall <br />submit the annual fee, a report and map showing the extent of current disturbances to aflecled land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated <br />to occur during the upcoming year, reclamation that will be performed during the coming; year, the <br />dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised annual resort map and written resort to this annual resort. Please <br />note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: i~lL ~GlaEtal-lf~~ Company: L/CF/~P-l~"t~ <br />Address: ~FJ `7U U% - ~ /ty~ Phone No.: (Tic'7 ) ~ 5 ~- ~ `J ~ 3~' <br />17~'N~~ ~ LC ~UrU~# FAX No.: (30'x) irh ~- 9 ~?~` <br />if there aze additional comments and/or information that should be provided to the Division, please <br />provide it on a separate sheet and attach it to this report form along with your map and/or written <br />report. <br />Signature of Corporate Officer, or Owner <br />/~ ~/o~ <br />Date <br />INSTX UCTIONS ON BACK <br />M:~PER M rI V.1ASTER DOCUM ENTSNI-AF-01 <br />