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-~'~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: r~/T Bone Stone, Inc. <br />~/ M-2004-030 <br />OPERATION NAME: T Bone Stone Quarry <br />ANNIVERSARY DATE: September 13, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Boulder <br />q~' J°~' <br />RECIE~`t~E~ <br />/~SEP 12 2006 <br />v Division of Reclamation, <br />Mining and Safety <br />According to C.R.S. 34-32.5-1 l6 or C.R.S. 34-32-1 l6, each year, on the anniversary date of the permit, an operator <br />shall cuhmit the annual fee, _a report and _map_showinglhe _extenLOf 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. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, resort, and associated <br />man (All 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: Bill Tenore <br />Permittee Name: T Bone Stone, Inc. <br />Address: 2337 Emery St <br />Longmont, CO 80501 <br />Phone Number: (303) 324-5021 <br />Fax Number: (303) 776-3839 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or a ach it t~s-farnralQng with your written report and map. Annual Report instructions are enclosed. <br />Officer, Owner, or Designee <br />~~ _0~ <br />