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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />• <br />~ ~~ <br />.~ <br />FEE n REPORT REQUEST <br />~ Four States Aggregates, LLC <br />~P~I-1990-025 <br />Hay Camp Pit <br />~~~~'~E® <br />~ APR 14 2008 <br />ivision of Reclamation, <br />Mining and Safety <br />May 22, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Montezuma <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=a_ceo_rr,-,dished to ~a~Jand during the-preced~ng~ear-, ~ncw disturbances-that are a~iticiputed 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: Kathy Stone <br />Permittee Name: Four States Aggregates, LLC <br />Address: P.O. Box 1568 <br />Cortez, CO 81321-1568 <br />Phone Number: (970) 565-3388 <br />Fax Number: (970) 565-0276 <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 />Signature f Corp to Officer, Owner, or Designee <br />~-~~~a~ <br />Date <br />