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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL ZEE and REPORT REQUEST <br />Monarch Stone Company <br />,/ M-1991-037 <br />Katuska Pit <br />May 3, 2007 <br /> <br />_~pR ~ 0100) <br />Division of ~~,;,,,amation, <br />~ Mining and Safety <br />$$281.00 (Due on or before your anniversary date) <br />Park <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~he~unual fee~a_report_and_map_ showing_the_extPnt of current di~rbances 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 [he 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 your revised written annual report and annual report mau to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, reuort, and associated <br />mau. If no new disturbances or reclamation have occurred during the previous vear and no new chances to <br />the previous year's map are necessary, then no new mau is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Anthony J. Kimmick <br />Pennittee Name: Monarch Stone Company <br />Address: P.O. Box 620216 <br />Littleton, CO 80162 <br />Phone Number: (303) 933-9657 <br />Fax Number: (303) 933-2370 <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 />r t <br />Si re of Corporate ~cer, weer, or Designee <br />-~6-~ <br />Date <br />