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~~~~ I I <br />ANNriAf, FF.F and REPORT RF.OiTF.ST RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />"M/ayne Industries, Inc <br />X41-1987-074 <br />Dotsero Quarry <br />October 9, 2005 <br />`/OCT 1 12005 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Eagle <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 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 ynnr revised written anmral re~nrt and annnal rr,Pnrt m~ to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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 />Pennittee Contact: Gerry A. Mayne <br />Permittee Name: Mayne Industries, Inc <br />Address: P.O. Box 1689 <br />Gypsum, CO 81637 <br />Phone Number: (970) 524-7733 <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 <br />S <br />Owner, <br /> <br />Date <br />