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es~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />v' ANNiiAi. FF,F, and RF.PnRT RF./7i1F.ST <br />v Everist Materials, LLC <br />i/M-1998-052 <br />Mascot Placer <br />July 22, 2006 <br />RECEIVED <br />yUL 0 6 2006 <br />vision of Minerals and lice-~~ ~ i <br />$688.00 (Due on or before your anniversary date) <br />Summit <br />~Yl~'2.. <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-cunentdisturbances 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 year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anmral report and annnal re~nrf m ~n to this form. The Annual Report <br />& Fee requirement is not met until we have received the following 3 components: fie. report, and associated <br />snap (All 3 are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note [hat an adequately labeled map that clearly delineates and includes the above elements may <br />suf}'ice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Greg Norwick <br />Everist Materials, LLC <br />CF.PR.address_i <br />P.O. Box 1150 <br />Silverthorne, CO -80498 <br />Phone Number: (970) 468-2521 <br />Fax Number: (970) 468-2756 <br />If you have additional comments and/or information that should be <br />below or attach it to this form along with your written report and map. <br />Signature of rp rate Officer, Owner, or Designee <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />~l~lo~ <br />Date <br />