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<br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />OCT252002 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNP/ERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Atkins Park Stone Corp. <br />M-1994-080 <br />Berthoud Sunset <br />October 28, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Lorimer <br />Division of Minerals and GeolgY <br />According to C.R.S. 34-32.5-I 16 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 an during t e preceding year, new [star antes that are anncipata [o occur - <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for [he 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 report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since fora Ivritten report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: -Tenya6eiser <br />Permittee Name: Atkins Park Stone Corp. <br />Address: 5975 NCR 27 <br />Joel Va-(d(ez <br />Loveland, CO 80538 <br />Phone Number: (970) 663-1920 <br />------Fax-Nnniber:---- (9-70)•663=23-1'S -- =- <br />If you have additional comments and/or information that should be provided to [he Division, please provide it <br />below or attach i[ [o this form along with your written report and map. Annual Report instructions are enclosed. <br />i/~ff/~~ XJ ~~I1/C - /~ <br />Signature of Corporate Offic r, Owner, or Designee <br /> <br />Date <br />M:~PERM IT~hIASTERDOCUM ENTSVN-AF-OI <br />