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?? k Ot <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Mayne Industries, Inc <br />PERMIT NO.: M-1987-074 <br />OPERATION NAME: Dotsero Quarry <br />ANNIVERSARY DATE: October 9, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Eagle -^ - - <br /> <br />OCT *t ,, ?buj <br />Division oi- ,<scjamation <br />R'ning and Safety <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 accompli-shed-toziate--and-during-the-precedingyear, 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 may 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: Gerry A. Mayne <br />Permittee Name: Mayne Industries, Inc <br />Address: P.O. Box 1689 <br />Gypsum, CO 81637 <br />Phone Number: (970) 524-7733 <br />Fax Number: <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 />A <br />or Designee <br />Date