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FF.OM <br />Blce Mt. Stone ~ PHONE N0. : 363 823 5868 . Oct. 22 1 III IIIIIIIIIIIII III <br />999 <br />~~fe.1 <br />ANNUAL REPORT <br />PERMTfTEE NAME: Blue Mountain Stone <br />PERMIT NO.: M81108 <br />OPERATION NAME: Pablo Vasquez Stone <br />ANNIVERSARY DATE: August 29, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Larimer <br />According to C.R.S. 34-32-116(3)(x), each.yeaz, on the anniversary date of the permit, an operator <br />-shall submit the annual fee, a repo'rt' and trap showing the exccnt of current disturbances to affected <br />land. reclamation accomplished to date and during the preceding year, new disturbances that arc <br />anticipated to occur' during the upcoming year, reclamation that will be performed during the coming <br />year, the dates for the beginning of active operations, and the date active operations ceased for the <br />year, if any. <br />Please attach vour revised annual reuort man and written report to this annual report. Please <br />note that an adegtuttely labeled mup that clearly delineates and includes the above elernentc may <br />.since far a written report. <br />Please type or print the ettrrent contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: it ~ l!l+SpteQZ.. <br />Address: 4i b4 u fe... ~4.~. <br />,tJi MnwJJ ~~ gbSo'3 <br />Company: BLtw,2./LITIJ. ~~,(~r <br />PhoneNo.:(3d3) Sz3-9~9~ <br />Fax No.: l 3a3) R`t.~- 653 <br />if there aze additional comments and/or information that should be provided to the Division, please <br />provide it on a separate sheet and attach it to this report form along with your snap and/or written <br />report. <br />~~?~ `~9 <br />Signatu rate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />