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~5 <br />ITEE NAME: <br />I' NO.: <br />TION NAME: <br />ERSARY DATE: <br />kL FEE DUE: <br />AT7NIT.AIJFii:R and FrR .PnRTIRFOi1RCT <br />Avalanche Creek Marble & Alabaster LLC <br />j~ M-1999-042 <br />Wblte Banks Mine <br />January 4, 2006 <br />Atlolpaa Pae tfetaal{y W uofsfain ~J <br />V ~Zt~3p (~ <br />a3ni3~3a <br />$225.00 (Due on ar before your anniversary date) <br />Pttkln <br />rding 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 <br />.tor shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />tbci'ainafion accbmplisFied-to d'a a of n3'3uririg-ihe preceding year, new distnr~es tFiat are antic"-- rp-'mated t`o <br />• during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />,Wing of acfive operations, and the date active operations ceased for the year, if any. <br />,b ynnr revise+l written annnal r ~~irl and nnnnat re~nrt mangy t_n thfs form- please note Jhat an <br />labeled map that clearly delineates and includes the above elements may since jor a written <br />records indicate the following perminee contact information. Please verify and make any necessary <br />Contact: Robert Congdon <br />Name: Avalanche Creek Marble & Alabaster LLC <br />0367 Avalance Creek <br />Cazbondale, CO 8.1623 <br />Phone Number: (970) 704-0547 <br />Fax Ntunber: (970)704-1669 <br />Sf you have additional comments andJor 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 <br />of Corporate Officer, Owner, or Designee <br />Date <br />