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~F ~ ~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Stone Wholesale Corporation <br />PERMIT NO.: M-1997-065 ,~ <br />OPERATION NAME: Brownstone Quarry <br />ANNNERSARY DATE: October 22, 2007 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <br />0 occG'~~li <br />~%oef X61 ~~ <br />n~o~a aaGa ~~~ <br />Sdf"~ °? <br />_ Accordin tg o C.R.S. 34_32_ .5-116 or~,R:S_34-326, aa~ear~oll_the_anniversarKdate_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 yeaz, 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 vour revised written annual report and annual report maa to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />maa. If no new disturbances or reclamation have occurred durinc the ureyious vear and no new chances to <br />the previous year's man are necessary, then no new mau is required, arovided that the Operator shall state <br />this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jim Striggow <br />Permittee Name: Stone Wholesale Corporation <br />Address: 11587 N. U.S. Highway 287 <br />LaPorte, CO 80535-9708 <br />Phone Number: (970} 221-0057 <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 />Signature o ' orporate fficer, Owner, or Designee <br />Date <br />