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AFiRFi <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />T Bone Stone, Inc. <br />NI-2004-030 <br />T Bone Stone Quarry <br />September 13, 2005 <br /> <br />~Et~EIVE~ <br />!/~Ep 0 9 2005 <br />Oivisian of Minerals and Gnolo9~; <br />$281.00 (Due on or before your anniversary date) <br />Boulder <br />e~^^toC.li 5.--34-32S-1~t6 or~,1?-5-34 32-116,-each_yea=-en-theanniver~ary-date-of the-Pemrit, an-operator - - <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written anm~al rennrt and anm~al report m ~n fn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: 1 <br />Permittee Contact: Bill Tenore <br />Permittee Name: T Bone Stone, Inc. <br />Address: 2337 Emery St <br />Longmont, CO 80501 <br />Fax Number: (303) 776-3839 <br />M4~ I} t ~1J I~t~Ys 4S~ SCtm~. 6 <br />Ya(Irr~ i~ A-n~iJ0.rs3S' iK N o w <br />t~ l2. S~ t~v-l/y ZaQd. ) ~ y2 <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />,$i re of Corporate Officer, Owner, or Designee <br />~_ ~ -~s- <br />Date <br />