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IIIIIIIIIIIIIIII <br /> ANNUAL FEE and REPORT REOUEST <br /> RECEIVED <br /> PERMITTEE NAME: Western Mobile, Inc. OCT 3 1 2001 <br /> PERMIT NO.: M-1996-082 <br /> OPERATION NAME: Blair Mesa Pit Division Of Minerals and Geology <br /> ANNIVERSARY DATE: November 15,2001 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Rio Blanco <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 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 tote that an <br /> adequately labeled map that clearly delineates and includes the above elements nay 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: ec entine JU If'P, 60e ,-Ynoedq.ON <br /> Permittee Name: Western Mobile, Inc. <br /> Address: t590-W-'t2th-Ave. [U <br /> Po, 130X 1 gg <br /> Devver_CO_80204 -: a f Co , es-2z <br /> Phone Number: (393-659-4330 (J"70) 'D-7` .'I& 9 <br /> Fax Number: (303)-6-5-7-4339— � 7d) 110'I- 2,907 <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 enclosed. <br /> 'w' t <br /> Vcaoe of Corporate Officer or Owner <br /> L%I0( <br /> Date <br /> NJ:TER MASTER DOC U M ENTSW-AF-01 <br />