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Q <br />F v <br />ANNUAL FEE and REPORT RE UEST <br />PERMITTEE NAME: Robert Daugherty <br />PERMIT NO.: M-2004-048 <br />OPERATION NAME: Cedar Point Picture Rock Quarry <br />ANNIVERSARY DATE: October 4, 2008 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <br />F <br />SEP 2 4 2008 <br />Divisi;.,: ... w . ?.:4,:. <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 />, _new disturbances that are anticipated to occur -_ <br />reclamation accomplished to date and during the precedingyear <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 vour 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 vear's map are necessarv, 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: Robert Daugherty <br />Permittee Name: Robert Daugherty <br />Address: P.O. Box 1364 <br />Clifton, CO 81520 <br />Phone Number: (970) 434-8773 <br />Fax Number: (970) 242-8438 <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 />gnature o Co rate icer, Owner, or Designee <br />--7 / Z 511 <br />Da e