REP47878

• Permit No: M1997064
• IBM Index Class Name: Report
• Doc Date: 7/7/2003
• Doc Name: Annual Fee Payment/Report
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Western Nutrients, Inc.
M-1997-064
Agri-Cal #1
July 9,2003
$225.00 (Due on or before your anniversary date)
Fremont
RECEIVED
JUL 0 7 2003
Division of Minerals and Geology
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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
~lan3 reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ~r revised written anm~al r nnrt and annual rennrt mad to this form. P/ease note that on
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Jerry Screws
Permittee Name: Western Nutrients, Inc.
Address: 11157 W. 76 Place
Arvada, CO 80005
(303 422-9509
Fax Number: [phone]
If you have additional comments andlor information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corporate Officer, Owner, or Designee
Date
M:IPERMITMASTERDOCUMENTS/M-AF-02. DOC