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a ~- <br />~. <br />ANNUAL EE and RE ORT REQUEST ~~~~~~® <br />PERMITTEE NAME:Carrizo Stone, LLC <br />PERMIT NO.: ~ M-2005-067 ~ MAY 012008 <br />~[ ivision of i~eciamation, <br />OPERATION NAME: Carrizo Stone North Mining and Safety <br />ANNIVERSARY DATE: May 3, 2008 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Baca <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 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 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: Stephanie and Ray Sikes <br />Permittee Name: Carrizo Stone, LLC <br />Address: 1425 County Road Q <br />Pritchett, CO 81064 <br />Phone Number: (719) 643-5325 <br />Fax Number: (719) 643-5327 <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 />0~cu,,,~,~~ ~ ~C,L~ <br />'gn re o/f~Corporate O ficer, Cdwner, or ignee <br />1' ~~ ~~~ <br />Date <br />