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t <br />- ~~ <br />ANNiIAi. FF.F, and RF,Pt7RT RF.niiF.ST <br />PERMITTEE NAME: Hall-Irwin Corporation <br />PERMIT NO.: M-2003-001 <br />OPERATION NAME: Nissen Farm Resource <br />ANNNERSARY DATE: November 21, 2004 <br />~/ <br />R~CEI V,~~ <br />NOV 10 Zgiq <br />Division of Minerals 8ntl Cablbgy <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Weld <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation_accompGshed~o date.and_dutin he nrece~ing_vear. new disturbances that are antic_i atp ed to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for [he beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach Ynnr revised written anneal rennrt and anneal re on rt m ~n to this form. Please note tltat 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 />Permittee Contact: Jeff Gregg <br />Permittee Name: Hall-Irwin Corporation <br />Address: 3026 4th Ave. <br />P.O. Box 2150 <br />Greeley, CO 80632 <br />Phone Number: (970) 352-6057 <br />Fax Number: (970) 352-6284 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or~ttach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />=Si ature Corporate Otffc6r, Owner, or Designee <br />~-l ~ ~ ~r <br />Date I I,, <br />n ~ ~,e ~lvnr~.~ ~cz~( V1~~S <br />,.` ~~oPol~e ~ ~ Z p~ <br />U <br />