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~ ~ F t <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />V <br />Sill Kobobel <br />M-1991-123 <br />Idaho Creek Resource <br />March 10, 2003 <br />RECEIi/E® <br />FEB 01 2003 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yea r~ 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 y~rr revised written anneal rennrf and anneal rennrt man to this form- 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: <br />Permittee Contact: Bill Kobobel <br />Perrtiittee Name: Bill Kobobel <br />Address: 7909 WCR 5 <br /> Longmont, CO 80504 <br />Phone Number: (303) 772-6916 - - --- - -- -- - <br />Fax Number: (303) 774-9808 <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 />Signature of Corporate Offic r, Owner, or Designee <br />~_ 2~-6~ <br />Date <br />M aPERMI'MIASTERDOCUMENTSUd-AF-OI <br />