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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Loukonen Bros. Stone <br />M-2000-090 <br />Lykins Gulch <br />February 1,2003 <br />RFCEoVED <br />FEBOy~ <br />Division of Minerals aadGeology <br />$281.00 (Due on or before your anniversary date) <br />Boulder <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-f e,,-a -report-and-map-showing-the-exten~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 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 your revised written anneal re~nrt and anneal rennrt m,~ to this form. Please note that on <br />adequately labeled map that clearly delineates and includes the above elements may since 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 Bros. Stone <br />Address: 12993 N. Foothills Hwy. <br />Longmont, CO 80503 <br />Phone Number: <br />Fax Number: <br />(303)823-6268 <br />(303)823-0843 <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 />~i~G%Zr~~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />/rL9~3 <br />Date <br />M:~PERMITMASTERDOCUMEMSU4-AF-01 <br />