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I~ <br />J <br />ANAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNLJAL FEE DUE: <br />COUNTY: <br />/High Plains Stone Company <br />~M-1990-016 <br />South 40 Quarry <br />July 11, 2007 <br /> <br />RECEIVED <br />~UN 0 6 2007 <br />Di ~ ion of ReG0n98U0n, <br />Mining and Safely <br />$$281.00 (Due on or before your anniversary date) <br />Fremont <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 />--- `shad-submit-tbe annual~ee; a-report~a fd map showing-thy extent of= cunenF di"stuibances -to affected--land, "- <br />-.` __._o____ _- <br />reclamation accomplished to date acid during the preceding year, new disturBances tfiat are aiRicipated'fo occar -- _ --- <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 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 during 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 Annaal 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 following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Debbie Wagner <br />Permittee Name: High Plains Slone Company <br />Address: P.O. Box 100 <br /> <br /> Castle Rock, CO 80104-0100 <br />Phone Number: (303) 791-1862 <br />Fax Number: (303) 791-1919 <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 Corporate Officer, Owner, or Designee <br />to -5-b'1 <br />Date <br />