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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Jake Kauffman & Son, Inc. <br />./M-1999-069 <br />Wagner/Kauffman Pit #3 <br />January 5, 2007 <br /> <br />REGE!~~FD <br />~bEC 2 7 2006 <br />plvlsion oTe d Safety n~ <br />/ Minlnp <br />$$688.00 (Due on or before your anniversary date) <br />Larimer <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-accomptished-to-date'and-during-the-preceding-yeaz,-new-disturbances that are-anticipated-to occur- I <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach vour revised written annual report and annual report map to this form. The Annual Report <br />Bc Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Fr~anyk~Kauffman ~~ ~y cy~~~~~, <br />Permittee Name: Jake Kauffinan & Son, hrc. <br />Address: 808 SCR 9E <br />Loveland, CO 80537 <br />Phone Number: (970) 667-1557 <br />Fax Number: (970) 667-9985 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~'~ 1~~~© <br />Date <br />