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fl~ ~- Q~ <br /> ANNUAL FEE and REPORT REQUEST <br /> <br />PERMITTEE NAME: J & K Limestone Products, LLC <br />PERMIT NO.: M-2000-116 ~/ <br />OPERATION NAME: J and K Limestone Products-Villa Grove Pit <br />ANNIVERSARY DATE: January 24, 2008. <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Saguache <br />~ra,v ~ .. ~ y,; <br />1u~ <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 />-_--=-r-eclamation-accomplished-to-date-anch-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 durinS the previous year and no new changes to <br />the previous year's man 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: Jim Willschau <br />~J9C 2~^~u /u~I9.~ <br />Permittee Name: J & K Limestone Products, LLC <br />Address: 1410 CR 2 E. <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-2760 <br />Fax Number: (719) 852-2685 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach i o this form alo ith your written report and map. Annual Report instructions are enclosed. <br />.. <br />Sign e of Co orate Officer, Owner, or Designee <br />~ ~~ <br />Date <br />