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:, <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Stone Wholesale Corporation <br />M-1997-065 <br />Brownstone Quarry <br />October 22, 2003 <br />0 ~~~~~~® <br />~~~~s~°" CT ©6 ~+ <br />of,~t~erats dn~CQOtoBY <br />$281.00 (Due on or before your anniversary date) <br />Larimer <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 />shall-submit-the-annual-fee,-a-report-and-map-showing-the-extent-of-current disturbances-to affected-tand,- <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 ynnr revised written anneal rennrt and anneal re n~ rt main to this form- Please note that on <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: Jim Striggow <br />Permittee Name: Stone Wholesale Corporation <br />Address: 9720 US Hwy 287 ~ / r8 7 /J, US NWv 2 $7 <br />i <br /> LaPorte, CO 80535-9715 <br />Phone Number: (970) 221_0057 _ <br />Fax Number: <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 />-2•D3 <br />Date <br />