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t/ <br />PERMITTEE NAME: L.G. Everist, Inc. ~C C' E' V~p <br />PERMIT NO.: M-2001-017 SAP ~ !~. X003 <br />OPERATION NAME: Lohmann Sand and Gravel Mine f)(Idsion of <br />Minerals and Geology <br />ANNIVERSARY DATE: September 19, 2003 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <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 />reciamauun accumpusneu w uare anu uunng uie preceuuig year, new uisruroances may are anucipa~eu iu 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 anm~al re~nrt and annnal reonH main to this form. please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lynn Mayer <br />Permittee Name: L.G. Everist, Inc. <br />Address: 7321 E. 88th Ave. Suite 200 <br />Henderson, CO 80640 <br />Phone Number: (303) 287-4656 C6'~ csz r~'^`y~ <br />Fax Number: (303) 289-1348 <br />3 -2~ ZZy 7 ~d; ~~~-) <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 />Signature of Corporate O ~cer, Owner, or Designee <br />Dq -~~ 03 <br />Date <br />M:~PERMITMASTEADOCUMENTSVN-AF-01 <br />