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iii iiiiiiiiiiiu iii <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Thornburg Family Limited Partnership RECE! VED <br />PERMIT NO.: M-1983-060 <br />OPERATION NAME: Thornburg Pit SEP ~ 3 2001 <br />Division of Minerals and Ceolo <br />ANNIVERSARY DATE: September 27, 2001 gy <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 [he 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 annual report and annual report map to this form. Please note that an <br />adequately labeled nrap that clearly ~leluteates mtd includes the above elemerus may suffice for a ~rritren report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permi[tee Con[acL' 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 shuuld 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 Officer or O ner <br />~y9~~~ <br />Date <br />ht'~PERM rnAt ASTERDOCUMENTSNI-AF-01 <br />