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~/ ~F / \ / ' <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: iCanyon Rim Stone, LLC <br />PERMIT NO.: ~I-2006-053 <br />OPERATION NAME: Canyon Rim Stone Quarry <br />ANNIVERSARY DATE: August 31, 2007 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <br />~~L <br />"'AUG 0 gZ007 <br />Division of kectamation, <br />C/ Mining and Safety <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 that are anticipated to occur <br />during [he 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 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 year and no new chances to <br />the previous year's map are necessary, then no new map 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 includes the <br />above elements may since for a written report. <br />Division records indicate the fallowing permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Florence Jackson <br />Permittee Name: Canyon Rim Stone, LLC <br />Address: 27500 CR 183 <br />Phone Number: <br />Fax Number: <br />Kim, CO 81049 <br />(719) 643-5435 <br />(719)643-5435 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signa~ ofte ficer~~ Designee <br />o~ <br />Date <br />