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N' ~ ~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rocky Road Investments <br />M-1985-210 <br />Rocky Road Quarry <br />January 27, 2004 <br />RECEIVED <br />JAN 2 7 2004 <br />Division ~f Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Latimer <br />According to C.R.S. 34-32.5-1 lb 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 acconlplisJred to date and during the preceding yeaz, 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 yeaz, if any. <br />Please attach vn++r revised written anneal report and anm+al ter rt man, to thi¢ fnrm_ Please »ote 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 perntittee contact information. Please verify and make any necessary <br />changes: <br />Permitter Contact; Douglas J. Baehli <br />Permitter Name: Rocky Road Investments <br />Address: P. O. Box 63 <br />Masonville, CO 80541 <br />Phone Number: <br />Fax Number: <br />(970)203-1072 <br />(970)669-8836 <br />If you have additional comments andlor 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 aze enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M~\PERMI'RMASTERDOCUMENTSM-AF-07 ~~~ <br />~~, <br />