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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />kO & A Stone LLC <br />AM-1994-121 <br />Vasquez Quarry No 2 <br />April 13, 2009 <br />a K- <br />APR 14 2009 <br />Divisioa or Reclamation, <br />Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Boulder <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_aecomphshed._tosiate, and_during_the_preceding-y-earrne_w_disturbances_that_are_anticipatedAo-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: Arturo & Beth Vasquez <br />Permittee Name: O & A Stone LLC <br />Address: P.O. Box 2526 <br />Longmont, CO 80501 <br />Phone Number: (303) 775-0201 <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 />C? <br />Signature of Corporate Officer, Owner, or Designee <br />H I t-,?,[oc? <br />Date