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r~ ~/ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />vANNUAL FEE and REPORT REQUEST <br />~ Farfrumwurkin, LLLP <br />~M-2004-047 <br />File Pit 112 <br />August 4, 2006 <br />RECEl~lED <br />'~AUG 011006 <br />t~Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />~~ <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 the extent of current disturbances to affected <br />- -land-reelsmaticn-aceomplished•to-date-and-during-±he-preceding-year; new-disturbancesdhat 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 Vour revised written annual report and annual report man to this form. Please note that an <br />adequately labeled map that clearly delineates and 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: Jan File <br />Permittee Name: Farfrumwurkin, LLLP <br />Address: 1163 Oakhurst Dr. <br />0 . ox .3 ii <br />Broomfield, CO 80020 li <br />~~v <br />Phone Number: (303) 404-3225 <br />Fax Number: (303) 404-0778 <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 />Signatur of Corporate Officer, Owner, or Designee <br />`7/3x/06 <br />Date <br />M:~PERMI'I WIASTERDOCUMENTSIM-A£-OM1 <br />