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/ANNiTAi. FF.F. 9nd RF.P[1RT R~iTF.CT <br />v x~r'rR~~~ <br />PERMITT'EE NAME: Green Brothers, Inc. `'°' '" `' <br />PERMTI' NO.: ,/ M-1995-030 !JUN 181006 <br />OPERATION NAME: Green Bros Ptt No 2 ~pjvisiaa o(Minerafs andGeafogi <br />ANNIVERSARY DATE: 7uly 7, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Morgan <br />According to C.R.S. 3432.5-116 or C.R.S. 3432-116, each yeaz,'on the anniversary date of the permit, an operator <br />--hall submit-the amtua-1'fee~ a report aad inap "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 yeaz, reclamation that will be perforated during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Plague 9tfnch ynpr revived written annngl retort and annnnl report map to thiv fnrm_ The Anneal Report <br />& Fee requirement is not met until we have received the following 3 rnmpopents: fee_ rennrt, and accnciated <br />map (All 3 are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jim F. Greea <br />Permittee Name: Green Brothers, lac. <br />Address: 19441 U.S. Hwy. 34 <br /> P.O. Box 858 <br /> Ft Morgan, CO 80701 - <br />Phone Number: (970) 867-2404 <br />Fax Number. (970) 867-2405 <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 />1 <br />gnature o Co orate Officer, Owner, or Designee <br />at <br />