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~K #~~oclfl ~ ~'2~! ~~ <br />! ~. <br />• III IIIIIIIIIIIIIIII • <br />ANNUAL REPORT <br />RECEI`'~ED <br />PERMITTEE NAME: Arkins Park Stone Corp. ~, 5 1L~~ <br />OCT <br />PERMTI' NO.: M-1994-080 <br />OPERATION NAME: Berthoud Sunset Division of R1iee:'~1; and GeeloBY <br />ANNNERSARY DATE: October 28, 2000 <br />ANNUAL FEE DUE ON ANNNERSARY DATE: $281.00 <br />COUNTY: Larimer <br />According to C.R.S. 3432-1-b(3~a?, each year, on theanniversary date of the permit, an operator shall <br />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 <br />to occur during the upcoming year, reclamation that will be performed during the coming year, the <br />dates for the beginning of active operations, and the date active operations ceased for the yeaz, if any. <br />Please attach vour revised annual report map and written report to this annual resort. Please <br />note that an adequately labeled map that clearly delineates at+d includes the above elen+e~:ts may <br />suffice for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: ~~htM~- ~etse~ <br />Address: 595 NC.2- a7 <br />l~e~.o?,d ~ ~sa~ <br />Company: rJYKI nr ('p V ~ Spa ne ~Otp. <br />PhoneNo.: (c9~6) (off-(~Zp <br />FAX No.:(87y) ~a6d-Z3lS <br />e-mail: QI'~InS ~ eZ IinK- ~ t~/~l <br />If there are additional comments and/or information [hat should be provided to the Division, please <br />provide it on a separate sheet and attach it to this report form along with your map and/or written <br />report. <br />Q._ lD~ZS~ <br />Signet re of orat Offic or Owner Date <br />INSTRUCTIONS ON SACK <br />M ~PERMfIIAtASTERDOCUMEM'SU7-AF-01 <br />