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ANNUAL FEE and REPORT REQUEST <br />~~ ~ <br />PERMITTEE NAME: v <br />Northern Colorado Constructors, Inc. Aggregate Div <br /> // <br />v <br />PERMIT NO.: M-2001-107 Rw=CEIVED <br />OPERATION NAME: NCCI Pit #1 <br />l~F 7 2 2001 <br />ANNIVERSARY DATE: February 27, 2007 <br /> ui ,un or ReGamation, <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary datey Mining and Safety <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 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 resort map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, resort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's man are necessary, then no new man is required, provided that the Ouerator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may sujfce jor a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Chris Zadel <br />Permittee Name: Northern Colorado <br />Address: 9075 WCR 10 <br />Ft. Lupton, CO 80621 <br />Phone Number: (303) 857-1754 <br />Fax Number: (303) 857-2933 <br />Constructors, Inc. Aggregate Div <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />