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~'I <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~ ~~~~ <br />AIVNIiAT. FF.F. and REPORT RF.OTIF.ST <br />A/rkins Park Stone Corp, <br />(,/111-1985-212 <br />Arkins Park Quarries <br />September 5, 2005 <br />$688.00 (Due on or before your anniversary date) <br />Larimer <br />~~j~ ~~ o b zoCS <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 />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 annual report and anmial rennrt maTfn 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 />Permittee Contact: Judy Sprague <br />Permittee Name: Arkins Park Stone Corp. <br />Address; 5975 NCR 27 <br />Loveland, CO 80538 <br />Fax Number: (970) 663-2315 <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 />~~,~ ~T~trn,o <br />Signature of Corporate Officer, Owner, or Designee <br />81a~ ~a5 <br />Date <br />