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r~` `nJ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />l~ ANNUAL FEE and REPORT REQUEST <br />Andesite Rock Company <br />M-1988-048 <br />Carr Gravel Resource <br />September 22, 2006 <br />R~CEIVEp <br />v SEP 112006 <br />+/ Division of Reclamation, <br />M~nrng and Safety <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />nn`~ <br />~ ~J~ <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 />reclamafion 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 of <br />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. The Annual Report & <br />Fee requirement is not met until we have received the following components: fee. report, and associated mae <br />(All are required regardless of the level of disturbance or absence of disturbance during the previous year). <br />Please note that an adequately labeled map that clearly delineates and includes the above elements may sufftce for <br />a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: JJ,, / <br />Permittee Contact: Lynn Mayer /L VIIJ ~ v <br />Permittee Name: Andesite Rock Company <br />Address: 7321 E. 88th Ave., Ste. 200 <br />Henderson, CO 80640 <br />Phone Number: (303) 287-4656 CWION+~, <br />Fax Number: (303) 289-1348 <br />~,L~3 ~ z~ 7 ~ <br />If you have additional comments and/or information that should be provided to the Division, please provide it below <br />or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corp rate Officer, Owner, or <br />Date <br />