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I~K <br /> <br />RECEluED <br />Longmont, CO 80503 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <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 repoif and map showing the extent of current disturbances to affected land, <br />reclamation-accomplished-te-date-and-during-the-preceding-years rew-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 report man~tn this form. Please Hole 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: Michael Loukonen <br />Permittee Name: Loukonen Brothers Stone <br />Address: 12993 N. Foothills Hwy. <br />Phone Number: (303) 823-6268 <br />Fax Number: (303) 823-0843 <br />JAN 0 9 ~0~ <br />O'iexianeRt Ahias:~y .r Iieolo9Y <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 Corpora e Officer, Owner, or Designee <br />//a~o 4 <br />Date <br />Loukonen Brothers Stone <br />M-1981-277 <br />Beech Hill Quarries <br />January 11, 2004 <br />$688.00 (Due on or before your anniversary date) <br />Boulder <br />M:~PERMITNIASTERDOCUM ENTSUI-A F-01 <br />