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PERMITTEE NAME: Andesite Rock Company <br />PERMIT NO.: M-1988-048 <br />OPERATION NAME: Carr Gravel Resource <br />ANNNERSARY DATE: September 22, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Weld <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 accomplished_to date_and during the_preceding_year, new disturbances-that aze 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 ym~r revised written anneal rennrt and anneal re nn rf mad to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may sufftce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lynn Mayer <br />Permittee Name: Andesite Rock Company <br />Address: 7321 E. 88th Ave., Ste. 200 <br />Henderson, CO 80640 <br />Phone Number: (303) 287-4656 <br />Fax Number: (303) 289-1348 <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 />