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~~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Leonard Loukonen <br />M-1986-085 <br />Weaver Quarry <br />December 5, 2004 <br /> <br />RECEIVE® <br />NOV t 0 2004 <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Lorimer <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 />'reclamation-aeeemplished-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 ~mn• reviced written anmeal report and annual rennrt mat to 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: Leonard Loukonen <br />Permittee Name: Leonard Loukonen <br />Address: P.O. Box 333 <br />Phone Number: <br />Fax Number: <br />Lyons, CO 80540 <br />(303)823-6268 <br />G,ISn ~~03~~ 7.3 - 4~ ~q <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 />Signature of Corporate~ficer,,Owner, or Designee <br />~~~~~-- ~ <br />Date <br />P o~ b0.~k <br />m0. <br />