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<br /> ANNUAL FEE and REPORT REQ UEST <br />PERMITTEE NAME: Stone Forge RECE1 VEp <br />PERMIT NO.: M-1991-147 JUL 15 ~ <br />OPERATION NAME: Quinn Quarry Division of Minerals ana Goalogy <br />ANNIVERSARY DATE: July 16, 2002 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Douglas <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator <br />shall submit_ th_e_annual fee, a_report_ and map showin>; 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 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 maa to this form. Please note that an <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 />Pernuttee Contact: Jack G. Quinn <br />Permit[ee Name: Stone Forge <br />Address: 620 W Henrietta Ave. <br />P. O. Box ]55 <br />~TTi~c.c+e~ M~ srdcxo.s ~P1~Rc~X- <br />~ ~~ 5 ~~ pr5ra R-B~ ~ , <br />nto R~cU}>'rr~J~a~ IaazFC Nis 6~ <br />G~t~e~ l'O OLRF . <br />Woodland Park, CO 80866 <br />Phone Number: (719) 687-9718 <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 />~~~~ • CL,~iGSr7-r <br />Signature of Corporate Officer or Owner <br />3 f2 X002 <br />Date <br />M:~PERMITMASTERD000MEMSN-I-AF-OI <br />