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~-- <br />~ ~ ~ ~ 1 ~~:--~-~.~ <br />,, ~~~ <br />ANNUAL ~E and REPORT REQUEST ~ <br />PERMITTEE NAME: /Bad Boy Stone Divisio„ ~, .; _ <br />PERMIT NO.: /M-1992-108 /ilinin~ ~,~_; 5`~yiyon, <br />OPERATION NAME: ./ Bad Boy Stone <br />ANNIVERSARY DATE: February 3, 2007 <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date) <br />COiJN'I'Y: 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 fee, a report and map showing the extent of current disturbances to affected land, <br />--' .reclamation-accomplished-to-date-and-derringshe-~re~eding ;~eac,_new_distrrbances_that_are_anticipateSLto occur <br />during the upcoming year, reclamation that will be performed during the coming yeaz, 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 resort maa to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, reuort, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the arevious 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 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: Pablo Vasquez <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Bad Boy Stone <br />11493 WCR 20 <br />Fort Lupton, CO 80621 <br />(303)857-4544 <br />(303)772-9447 <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 />~a b to ~/~sAt~w <br />Signatur of Corporate Offic r, Owner, or Designee <br />.1S-a~- <br />Date <br />