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~, <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Bill Kobobel <br />M-1991-123 <br />Idaho Creek Resource <br />March 10, 2002 <br />RECEIVED <br />MAR 0 6 2002 <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 year, on the anniversary date of the permit, an operator <br />shalt submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />'raCFamaiitSrr`az<cbirp'3tsiiC-to uat~ard'darittg'ttte praCe3ittg-y2ar,`new=di"stu~atices that-are-anticipated-to occuT- <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 annual report and annual report map 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 permi[tee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bill Kobobel <br />Permittee Name: Bill Kobobel <br />Address: 7909 WCR 5 <br />Phone Number: <br />Fax Number: <br />Longmont, CO 80504 <br />(303) 772-6916 <br />(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 />r <br />Signature of Corporate Officer or caner <br />2 - /~ - ~ 2---- <br />Date <br />M:~FERMIT\MASTERDOCUMENTSUI-AF-01 <br />