REP45204

• Permit No: M1992108
• IBM Index Class Name: Report
• Doc Date: 7/2/2004
• Doc Name: Cert. Copy AF & RPT Request
• From: DMG
• To: Bad Boy Stone
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Bad Boy Stone
M-1992-108
Bad Boy Stoue
February 3, 2004
$281.00 (Due on or before your anniversary date)
Boulder
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding yeaz, new disturbances that aze anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach yanr revised written anmial reQnrt and annnal red nrt map to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Pernvttee Contact: Pablo Vasquez
Permittee Name: Bad Boy Stone
Address: 11493 WCR 20
Fort Lupton, CO 80621
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of Corporate Officer, Owner, or Designee
Date
M:~PERMIINIASI"ERDOCUMEN'1'SM-AF-01