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<br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Weld County <br />M-1980-149 <br />Hokestra Pit No 1 <br />March 1, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />to C.R.S. 34-32.5-116 or C.R.S. <br />FEB 2 5 2003 <br />Divlslan of Minerals and Geology <br />operator shall submit the annual tee, a report and map showing the extent of current disturbances [o 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 ynnr revised written annual re~nrt and annual re~nrt m to this form- Please note [hat 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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Greg Nelson <br />Weld County <br />P.O. Box 758 <br />1111 H St. <br />Greeley, CO 80632 <br />(970)356-4000 <br />(970)304-6497 <br />u ~ 75~ <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 />ignature JlCorpo99rate Officer, Owner, or Designee <br />~/°ZJla3 <br />Date <br />MiPERMINNASTERDOCUMENT5UI-AF-04 <br />