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<br />~_ . <br />PERMITTEE NAME: <br />PERMTT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Weld County <br />M-1983-213 <br />Lehr Gravel Pit <br />March 1, 2002 <br />RECEIVED <br />FES 2 2 2002 <br />ptuision at Minerals end Iie01o9Y <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 />__ _v land,_reclamation accomplished to date and during the preceding year, ne__w_disturbancesthat.aze,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 map 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 infotTnation. 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 />ll 11 H St <br />Greeley, CO 80632 <br />(970)356-4000 <br />(970)304-6497 <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 />Signature f Corporate Officer or Owner <br />~Z~/~lD~ <br />Dale <br />M iPERMITVv1ASTERD000MENTSN4-AF-W <br />