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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />14'r "' F <br />ANNUAL FEE and REPORT REQUEST <br />PLarsen Colorado, L.L.C. <br />0VI-2007-014 <br />Byzantine Quarry <br />December 6, 2008 <br /> <br />%O'V 1 ? 2000 <br />Division w ;-iru;,iamacon, <br />Knino ad Sai22y <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <br />oK, <br />bM, - <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 may 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: Norbie Larsen <br />Permittee Name: Larsen Colorado, L.L.C. <br />Address: 927 Highway 115 <br />P.O. Box 670 <br />Penrose, CO 81240 <br />Phone Number: (719) 372-7114 <br />Fax Number: (719) 372-7118 <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 of Corpo ate Officer, Owner, or Designee <br />_n /[b c a ff <br />Dat