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III IIIIIIIIIIIII III <br /> 999 RECEIVE® a <br /> SEP 2 1 2001 <br /> ANNUAL FEE and REPORT REQUEST <br /> Division of Minerals and Geology <br /> PERMITTEE NAME: Castle Concrete Company <br /> PERMIT NO.: M-1977-376 <br /> OPERATION NAME: Canyon Dolomite Quarry <br /> ANNIVERSARY DATE: September 22,2001 <br /> ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br /> COUNTY: Fremont <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 /> 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 map that clearly delineates and includes the above elements may since for a written report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: _ <br /> Permittee Contact: Je ans <br /> PermitteeName: ny fodn ryX \\ r^c,1z <br /> Address: P O Box 2379 LA � IL&O COST���u ee� <br /> Colorado Springs, CO 80901 U0A <br /> Phone Number: (719)475-0700 <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 /> t " <br /> Signatur f Corporate Officer or Owner <br /> Date <br /> M.IPERMHAMASTERDOCUxIENrSVA AF-01 <br />