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<br />;. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Western Mobile Southern, loc. <br />M-1990-112 <br />State Pit <br />June 15,2001 <br />(~cJ <br />REC~~~~® <br />MAY 2 2 2001 <br />division o/Minerdtg and ~eologY <br />$688.00 (Due on or before your anniversary date) <br />Pueblo <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 <br />operator shall submit the annual fee, a report and map showing [he 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. Please Wore That an <br />adequately labeled map that clearly delineates mrd includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Eric Reckentine <br />Permittee Name: Western Mobile Southern, Inc. <br />Address; 1590 W. 12th Ave. <br />Denver, CO 80204 <br />Phone Number: (303) 657-4330 <br />Fax Number: (303) 657-4339 <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 />~~ ~~ 7~-~~-~% <br />Signature of Corporate Officer or Owner <br />~~/~i <br />Date <br />• iii iiiiiiiiiiiu iii • <br />999 <br />ANNUAL FEE and REPORT REQUEST <br />M ~PERMnN1A5TERDOCUP.tENT5Vv1-AF-01 <br />