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iiiiiiiiii iii <br />PERMTI'TEE NAME: -Bavid-Baeen-&-Glenn Southwick RECEIVE~~ <br />PERMIT NO.: M-1986-007 Mpa U 2 2000 <br />OPERATION NAME: Masonville Stone Division of Minerab & ~eotog~ <br />ANNNERSARY DATE: March 11, 2000 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Larimer <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an operator shall <br />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 <br />to occur during the upcoming year, reclamation that will be performed during the coming year, the <br />dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised annual report map and written report to this annual report. P/ease <br />note that nn adequately labeled map thus clearly delineates and includes the above elements tray <br />since for a written report. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: ~I~n Stil3'~'tl.y <br />Address: 1~CJ ~X 1 ~i <br />Company: I~f1SOnU• I I~' S~n~, <br />PhoneNo.: (q~y ) Sig- ~5~9 <br />FAXNo.:(q~y) Slog- (~(oDoZ <br />If there are additional comments and/or information that should be provided to the Division, please <br />provide it on a separate sheet and attach it to this report form along with your map and/or written <br />report. <br />ignature of orporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />M: WERM fM1ASTERD000M ENTSUI-AF-01 <br />