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f <br />/~ F r <br />ANNU ~ EtE an REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />'Carrizo Stone, LLC <br />i/M-2005-067 <br />Carrizo Stone North <br />May 3, 2007 <br />~t~' ~ 2~99I <br />~ Ision q; fi, ,, <br />Mining sr;4 & ~ ~, <br />$$281.00 (Due on or before your anniversary date) <br />Baca <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 land, <br />reclamation accomplished to date and during the preceding year-new-disturbances-thaYare anticipated-to-occur <br />during the upcoming yeaz, 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 vour revised written annual report and annual reuort map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's man are necessary, then no new man is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and incdudes the <br />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: Stephanie and Ray Sikes <br />No CN~~~.~~~F~ ~ <br />Permittee Name: Carrizo Stone, LLC <br />Address: 1425 County Road Q <br />Pritchett, CO 81064 <br />Phone Number: (719) 643-5325 <br />Fax Number: (719) 643-5327 <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 />Corporate Officer, Owner, or <br />~~-O~ <br />Date <br />