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. r' <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />( Y~ <br />Z ~ ~~ ~~~ <br />ANNUAL FEE and REPORT REQUEST <br />Hall-Irwin Corporation <br />M-1997-058 <br />Baseline Resource <br />February 12,2002 <br />RECEIVED <br />FEB 1 3 2002 <br />Division of Minerals 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. 34-32-1 16, each year, on the anniversary date of [he permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during"the precediiSg 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 your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map than clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: - r°r-~~ "~°=bg <br />Permittee Name: Hall-Irwin Corporation <br />Address: P O Box 519 <br />Greeley, CO 80632 <br />Phone Number: (303) 654-1684 <br />Fax Number: (970) 352-6284 <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 />c ~~/ <br />~.v!/ - <br />S' ature o Corporate Officer or Owner L ~ ~~~ <br />Date <br />M:~PERMITVNASTERDOCUMENTSU-I-AF-O7 <br />