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t~ <br /> <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Western Cleanup Corporation <br />M-1950-135 <br />Headley Farms <br />October 7, 2002 <br />OCT 182002 <br />Division of Minerals and Deology <br />$688.00 (Due on or before your anniversary date) <br />Morgan <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator <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 performed 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 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 report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Pemuttee Contact: Ron Greene <br />Permittee Name: Western Cleanup Corporation <br />Address: 1320 E. Burlington Ave. <br />Fort Morgan, CO 80701 <br />Phone Number: (970) 867-9507 <br />Eax.Numbec~_--E970)-542-0765-- <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 fo ^along with your written report and map. Annual Report instructions are enclosed. <br />of <br />,Owner, or Designee <br />Oe?" /0 2 ~ z. <br />Date <br />M:~PERM ITVNASTERDOCUMENTSNI-AF-OI <br />