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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />L. G. Everist, Inc. <br />M-1999-120 <br />Ft. Lupton Sand and Grave[ Mine <br />June 1, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />RECEIVED <br />JUN 0 2 2003 <br />Division ~f Minerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator I <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation~accomplished'to date and during-the preceding year, new disturbances that are anticipated to occur I <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written anneal refit and anneal reRttrt ma~tn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffrce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lynn Mayer <br />Permittee Name: L. G. Everist, Inc. <br />Address: 7321 E. 88th Ave. Ste. 200 <br />Henderson, CO 80640 <br />Phone Number. (303)287-4656 CM~'+~t) ,3o3-2$b-22~/7 I~e~ <br />ax umber: (303287=8076- -" <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 />Officer, Owner, or Designee <br />r1 1. <br />Date <br />M:\PERM ITU1 ASTERDOCUMENTS\M-AF-01 <br />