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N t~ <br />S~ s <br />ANNTiAi. FF.F. and RF.PnRT RF.L7iTFST <br />PERMTI'TEE NAME: Mayne Industries, Iuc ~i, '- <br />PERMIT NO.: M-1987-074 ACT <br />OPERATION NAME: Dotsero Quarry 1 ~ ~b~ <br />Division of MineralsC ®oelB(fy <br />ANNPJERSARY DATE: October 9, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Eagle <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 />- - reclamafion 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 far the year, if any. <br />Please attach ynnr revised written annual resort and annual re;Pnrt main to this form. Please note that 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: <br />Permittee Contact: Robert V. Mayne <br />Permittee Name: Mayne Industries, Inc <br />Address: P.O. Box 1689 <br />~c~_,~~t. L~ rC, <br />Gv~S~o aa~ ~ CD ~6 ~~~ <br />Gypsum, CO 81637 <br />Phone Number: (970) 524-7733 <br />Fax Number: <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 />~~ <br />Signatur Corporate O facer, O r, or Designee <br />Date <br />