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ANNUAL FEE and REPORT REQUEST <br />.~ <br />RECEIVED <br />PERMITTEE NAME: Western Slope Flagstone <br />PERMIT NO.: M-1996-076 APR ~ 5 2Q~2 <br />OPERATION NAME: Western Slope Flagstone Quarry No. 2 Division of Minerals and Geology <br />ANNNERSARY DATE: April 16, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing [he extent of current disturbances to affected land, <br />reclamation'accomplished-tti da2'and uuriu~iire-precedingrycar,' ncw-li irnnbancesihat-are-anticipated to-cccar- <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 annual resort and annual report map to this form. Please note 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: Rudolph Fontanari <br />Permittee Name: Western Slope Flagstone <br />Address: 3316 E. 3/4 Rd. - Rt. 1 <br />Clifton, CO 81520 <br />Phone Number: (970) 434-7948 <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 />(/~ (T'r'io j <br />Signature of Corporate Officer or Owner <br />Oa-- <br />Date <br />M:V'ERMITUTASTERDOCUMENTSVN-AF-01 <br />