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9,~L <br />l'I i~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ANNiIAI. FF.F, and REPORT RF,niTFST <br />r/Weld County <br />~M-1981-286 <br />Thomas Gravel Pit 4 <br />March 1, 2006 <br />~~C~IVe ~ <br />MAR 0'12006 <br />Division of Mmetals and Geology <br />$688.00 (Due on or before your anniversary date) <br />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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to 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-comin; <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />please attarh ymm revised written annual rennrt and annnal report mttp 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: Greg Nelson <br />Permittee Name: Weld County <br />Address: 1111 H St. <br />P.O. Box 758 <br />Phone Number: <br />Fax Number: <br />Greeley, CO 80632 <br />(970)356-4000 <br />(970)304-6497 <br />(~-zol 30~ -~y~, 6 <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 />Signa re of porate Officer, Owner, or Designee <br />~~~~~~o~ <br />Date <br />M:~PERMITNrASTERD000MENTSNr-AF-04 <br />