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l <br />V <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Faur States Aggregates, LLC <br />M-1990-025 <br />RECE{VED <br />Hay Camp Pit <br />May 22, 2003 MAY 141003 <br />$688.00 (Due on or before your anniversary dat~~ision of Minerals and Geology <br />Montezuma <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the ann_ iversary date.of the permit, an operator <br />shall submit the annual fee, a report and map showing [he 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 yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ym~r revised written annnal report and annnal report main to this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since jor a written report. <br />Division records indicate the following pemrittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Aryol Brumley <br />Permittee Name: Four States Aggregates, LLC <br />Address: P.O. Box 1568 <br />Cortez, CO 81321-1568 <br />Phone Number: <br />Fax Number: <br />(970)565-3388 <br />(970)565-1057 <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 aze enclosed. <br />Date <br />M:~PERMITMASTERDOCUMENTSU~I-AF-01 <br />~~~Z~Q~ <br />