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<br />RECEIiiEC <br />SEP 11 2004 <br />PERMITTEE NAME: Thornburg Family Limited Partnership <br />PERMIT NO.: M-1983-060 DIVISIOa Of Minerals and Gealoyy <br />OPERATION NAME: Thornburg Pit <br />ANNNERSARY DATE: September 27, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Adams <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-dishrcbances_that_are_anticipated.to occr~~ _ <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 ynnr revised written anneal report and annual re,Rprt 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 permittee contact information. Please verify and make any necessary <br />changes: <br />Permi[tee Contact: Stanley Thornburg <br />Permittee Name: Thornburg Family Limited Partnership <br />Address: 50747 E. 38th Ave. <br />Bennett, CO 80102 <br />Phone Number: (303) 644-3424 <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 to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of orporate Officer, Owner, or signee <br />S,~ Pi is ~y <br />Date <br />