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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANN[JAL FEE DUE: <br />COUNTY: <br />Loukonen Bros. Stone Company <br />M-2001-114 <br />Starks Quarry <br />August 26, 2004 <br />REGE@~E® <br />AUG 12 2004 <br />Oirision of Minerals & 6eoloAY <br />$281.00 (Due on or before your anniversary date) <br />Larimer <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 current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to-csccur--- <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 annual re~nrt and annnal report m ~n to this form. please note that an <br />adequately labeled map that clearly delineates and includes [he above elements may 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: Michael Loukonen <br />Permittee Name: Loukonen Bros. Stone Company <br />Address: 12993 N. Foothills Hwy. <br />Longmont, CO 80503 <br />Phone Number: (303) 823-6268 <br />Fax Number: (303) 823-0843 <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 />-lsli~ ~tA.Y <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />