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Nr`' <br /> A~ ~- RPT <br /> ANNUAL FEE and REPORT REQUEST <br /> /~ <br />PERMITTEE NAME: H & H Stone <br />PERMIT NO.: / <br />M-1998-080 / <br />OPERATION NAME: H & H Quarry #2 <br />ANNIVERSARY DATE: November 27, 2007 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Dolores <br />~ ~~n~~ <br />~ivision~~ ®~ ~~~~~ / <br />Mini%9 ~r~q ~~~~ ~ ,~ <br />D <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 affect d land,_y <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 annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Fred & Marty Holley <br />~~77~r /~fll/e.c, <br />Permittee Name: H & H Stone <br />Address: P.O. Box 250 <br />Dove Creek, CO 81324 <br />Phone Number: (970) 677-2767 <br />Fax Number: (970) 677-2921 <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 />ignature of Corporat facer, Owner, or Designee <br />~/- ~©-~~ <br />Date <br />