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~_: ,. <br />.. ~ ~~ <br />~~ ~ <br />ANNi1Ai. FF,F, and RF.PnRT RF.Oi1F.ST ~, ,i : i ~,' `, ~~ <br />vi~~i~aion of 1i:iuernls & Geolo~r <br />PERMITTEE NAME: Northern Colorado Constructors, Inc. Aggregate Div <br />PERMIT NO.: M-2001-107 <br />OPERATION NAME: NCCI Pit #1 <br />ANNNERSARY DATE: February 27, 2005 <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 />- ---reclamation-aecemplished-to-date-and-during-the-preceding-year-,-nc~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 re,Pnrt main to this form- Please note that an <br />adequately labeled map that clearly delineates and incdudes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Chris Zadel <br />Permittee Name: Northern Colorado Constructors, Inc. Aggregate Div <br />Address: 9075 WCR 10 <br />Ft. Lupton, CO 80621 <br />Phone Number: (303) 857-1754 <br />Fax Number: (303) 857-2933 <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 />Signature of Corporate Officer, Owner, or Designee <br />IIIo~cS <br />Date <br />