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/~ <br />~-CtS <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/ANNUAi, FF,F, and RF.Pt1RT RF.nUF.RT <br />IMP Blips Stone Company <br />~ M-1981-075 <br />Phillips Stone Company <br />July 30, 2006 <br />R~CEd!!ED <br />/JUL 121Q06 <br />/i0iuision of Minerals and CeologY <br />$281.00 (Due on or before your anniversary date) <br />Boulder <br />" Accordictg io C;R:S-34=32:5=1'16-arC:R:S-34=32=1-ICr, eachy-ear, orrtheann:versarytlah-sf the permit; an-aperatsr- --- • <br />shall submit the annual fee, a report and map showing the extent of cun•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 your revised written anneal report and annual r~pnrt mare to this form. The Annual Report <br />& Fee requirement is not met until we have received the following 3 components: fee, r~p2(, and associated <br />map (A113 are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />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: Robert J. Phillips <br />Permittee Name: Phillips Stone Company <br />Address: 7850 Ute Hwy <br />Longmont, CO 80503 <br />Phone Number: (303) 823-6395 <br />Fax Number: (303) 485-2706 <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 />~~ <br />Signature of Corporate O •er, Owner, or Design <br />Date /D ~~ <br />