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999 <br /> ANNUAL FEE and REPORT REQUEST RECEIVED <br /> PERMITTEE NAME: Mountain Aggregates, Inc. JAN 3 12001 <br /> PERMIT NO.: M-1977-534 Division of Minerals and Geology <br /> OPERATION NAME: Empire Pit <br /> ANNIVERSARY DATE: January30,2001 <br /> ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br /> COUNTY: Clear Creek <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 <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br /> occur during the upcoming year, reclamation that will be performed during the corning year, the dates for the <br /> beginning 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 laheled map that clearly delineates and includes the ahove elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please erify and make any necessary <br /> changes: <br /> Perinittee Contact: AI Hayden <br /> Permittee Name: Mountain Aggregates, Inc. <br /> Address: P.O. Box 535 <br /> Castle Rock, CO 80104 <br /> Phone Number: (303) 688-4890 <br /> Fax Number: (303) 688-7497 <br /> If you have additional continents 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 <br /> enclosed. <br /> Signature of Corp rate Officer or Owner <br /> 3/- / <br /> Date <br /> N4 TERMITMASTERDOCUMENTNN-AF-01 <br />