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~~ ~ ~~ <br />~~~~~~~~ <br />ANNUAL FEE and REPORT REQUEST <br />aPR z s zoos ~,~, <br />PERMITTEE NAME: Arkins Park Stone Corp. Division oi- heCiamation, `~ <br />PERMIT NO.: M-1985-211 t// ~0n~n9 and Safety v <br />OPERATION NAME: Berthoud Pink Quarry <br />ANNIVERSARY DATE: Apri129, 2008 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <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 lap _ <br />~- - re¢larnation~ceemplished.-to=date and-•during_-the-pr~ceding~-yea~ne~ diofi~rh-~~~c_±hWt_~_ a~;~=.~,~te=d_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: Arlis M. Sprague <br />Permittee Name: Arkins Park Stone Corp. <br />Address: 5975 NCR 27 <br />Loveland, CO 80538 <br />Phone Number: (970) 663-1920 <br />Fax Number: (970) 663-2315 <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 />~~.5~ <br />Signature of Corporate Officer, Owner, o Designee <br />Date <br />