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.[~M ~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ANNITAT, FF.F, and REPORT RF.(,~TiF.ST <br />(/ High Plains Stone Company <br />i I-1990-016 <br />South 40 Quarry <br />July 11, 2006 <br />I~ECEIyED <br />`7UN 3 0 2006 <br />(/ uivision of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Fremont <br />--- -According-to-C.R.S. 34-32.5-1-16 or-C.R:S-34-32-1-1b; each-year-on-the-anniversary-date-of-the-permit; an opersior- <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 anneal rennrt and anneal r~nnrt nt.~f to this form- The Annual Report <br />& Fee requirement is not met until we have received the following 3 components: feeTre nrt, and associated <br />yta~ (A113 are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and incdudes the above elements may <br />since for a written report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary I <br />changes: <br />PermitteeContact: Seats-8dagrter ~~pb ~ Q (f~/~ a Y/ <br />Permittee Name: High Plains Stone Company <br />Address: P.O. Box 100 <br />Castle Rock, CO 80104-0100 <br />Phone Number: (303) 791-1862 <br />Fax Number: (303) 791-1919 <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 />Signature of Corporate Offtcer, Owner~r Designee <br />-aq- <br />Date <br />