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w~ <br />,4Fi;~Pr- <br />PERMITTEENAME: '~ltobertDaugherty RECEIVED <br />PERMIT NO.: ~-2004-048 vSEP 212005 <br />OPERATION NAME: Cedar Point Picture Rock Quarry <br />Division of Minerals and Genle~y <br />ANNIVERSARY DATE: October 4, 2005 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <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 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 ymrr revised written anneal re,~nrt and anneal report mzn to this form. Please note thaf an <br />adequately labeled map that clearly delineates and includes the 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: ~7 <br />Permittee Contact: Robert Daugherty l // it ~ .S ~'Bl~sca/! !~ ~l G <br />Permittee Name: Robert Daugherty -5 ld.~/ ~ <br />Address: P.O. Box 1364 <br />Clifton, CO 81520 <br />Phone Number: (970) 434-8773 <br />Fax Number: (970) 242-8438 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />S~'fgnature of C porat fficer weer, or Designee <br />~/ /.~- <br />Date T <br />