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(1I 'I1'III1I"I1 '11 /1�lk <br /> sss <br /> ANNUAL FEE and REPORT REOUEST "V ED <br /> RECE <br /> PERMITTEE NAME: Colorado Lien Company SEP �p01 <br /> PERMIT NO.: M-1477-301 13704. ul Minerals and Geology <br /> OPERATION NAME: Roberts Quarry <br /> ANNIVERSARY DATE: September 22,2001 <br /> ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br /> COUNTY: Larimer <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 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 man to this Form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice fo,a written report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Lecia Craft <br /> Permittee Name: Colorado Lien Company <br /> Address: P.O. Box 767 <br /> Rapid City, SD 57709 <br /> Phone Number: (605) 342-7224 <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 is along with your written report and map. Annual Report instructions are enclosed. <br /> S' nature of Corp ate Officer or Owner <br /> Date T' <br /> M1a TE R M FM1 ASTER DOC U M ENT S W-A F-01 <br />