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RECE11~Ep <br />ANNUAL FEE and REPORT REQUEST APR 15 2002 <br />Division of Minerals and Geology <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Arkins Park Stone Corporation <br />M-1985-211 <br />Berthoud Pink Quarry <br />Apri129, 2002 <br />$281.00 (Due on or before your anniversary date) <br />Larimer <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of [he 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 vour 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 for a written report. <br />Division records indicate the following pemtittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tanya Geiser <br />V <br />Permittee Name: Arkins Park Stone Corporation <br />Address: 5975 NCR 27 ~ <br />S <br />Loveland, CO 80538 ~ <br />In <br />Phone Number: (970) 663-1920 n <br />Fax Number: _I~ ~ - ~D fo 3- o"~ ~(S <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 />(~' N <br />S~ ature Corporate Officer or Owner <br />4J~~/oZ <br />Date <br />l '~- <br />M:~PERMnw7ASTERD000MENTSU~-AF-OI <br />