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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT R~'~"E~ <br />MAY 2 3 ^" ~ <br />Four States Aggregates, LLC LnuGs <br />M-1990-025 Division of Minerals Sod Geology <br />Gardner Pit No 2a <br />May 22, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Montezuma <br /> <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 wri-ent 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 mau to this form. Plense note rhnt 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 />Permittee Contact: Aryol Brumley <br />Permittee Name: Four States Aggregates, LLC <br />Address: P.O. Box 1568 <br />Cortez, CO 81321-1568 <br />Phone Number: (970) 565-1057 _ _ _ <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 o Corpo to Officer or O r <br />5 ~ 2-p~ pY <br />Date <br />M:~PERMITN4ASTERDOCUMEMSNI-AF-01 <br />