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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bestway Paving Company <br />M-1977-315 <br />Pit No. 1 <br />Apri123, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />RECEIVED <br />APR 2 12003 <br />Division ~f Minerals and Geology <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 />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 err revised written annna! report and annual rennrt m ~n to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Carl V. Hill <br />Permittee Name: Bestway Paving Company <br />Address: "' "rn-rr-3-irre+yo~ <br />~I~~lb~ P o. sox -3.30633 <br />Greeley, CO ~863~-IPj p(p33 <br />Phone Number: (970) 353-1654_ <br />Fax Number: (970) 353-5089 <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 />~~ <br />Signa re of Corporate Officer, Owner, or Designee <br />Date <br />M1PERMITUTASTERD000MENTSU~I-AF-0I <br />