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<br />,. <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Hall-Irwin Corporation <br />M-1997-058 <br />Baseline Resource <br />February 12,2005 <br />$688,00 (Due on or before your anniversary date) <br />Weld <br />REC~IV~~ <br />JAN 31 ~ <br />~ivisi°° of Minerals and CeologY <br />~~~ <br />ording4o-C-R:S-34-32-5-1-f6.onC.B..S_34-32116,.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_accomplished-to-date-and during the-preceding-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 ynnr revised written anneal rennrt and anneal re nn rt mad to this fnrm_ 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: \ Q <br />Permittee Contact: Jim McFazland Je \ I ~ ('eqC~ <br />Permittee Name: Hall-Irwin Corporation <br />Address: P.O. Box 519 . o . t 2LSo <br />Greeley, CO 80632 <br />Phone Number: (303) b54-1684 <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 />tgnatur of Corpo t OfFicer, Owner, or Designee <br />i >/2~,aS <br />Date ~- <br />