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DEC-30-2000 02:12PM FROM-DIV RECLAMATION MIN{NG & SAFETY +3038328106 <br />PERMITTEE NAME: <br />PERMIT NO.- <br />OPERATION NAME- <br />ANNUALS FIEF an 43RT F 1E7E 7' <br />---------- Ile <br />Jake Kauffman & Son, Inc <br />?M_1999-069 <br />Wagnerf auffman Pit #3 <br />ANNIVERSARY BATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />January 5, MO <br />T-333 P.002/002 F-088 <br />c> I<' <br />ecs <br />C?E® <br />/A L17 2010 <br />Divi6ion of Reclamation, <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary elate) <br />Larimer <br />According to C.R.S. 34-325-116 or C.R.S. 34-32-116, each year, 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 your revised written annual report and annual report maR to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fees report, and associated <br />ma . If no new disturbances or reclamation have occurred during the previous Year and no new changes to <br />the orevious year's map are necessary then na new map is reouired, provided that the Operator shall state <br />this in the Annual Report.. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify-and make any necessary <br />changes- <br />Perm ittee Contact: Frank Kauffman <br />Pennittee Name: Jake Kauffman & Son, Inc <br />Address: 808 SCR 9E <br />Loveland, CO 84537 <br />Phone Number: (970) 667-1557 <br />Fax Dumber: (970) 667-9985 <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 Corpo t Of[°icer, O +r, or Designee <br />/- y -,,2alD <br />Date