2009-05-01_REPORT - M2005067

• Permit No: M2005067
• IBM Index Class Name: REPORT
• Doc Date: 5/1/2009
• Doc Name: Annual Fee/Report/Map
• From: Carrizo Stone, LLC
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: JLE
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
? J
ANNUAL FEE and RE ORT REQUEST
Carrizo Stone, LLC
(I /-. ?-2005-067
Carrizo Stone North
May 3, 2009
O?

$$323.00 (Due on or before your anniversary date)
Baca
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
- ---during-the-upeoming-year,-=reelamat-ion-tha --wi+l-?€arnied-during°the--eo in- Fear,°?lie-4ates fo `he-b -
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous vear's man are necessarv. then no new map is reauired, provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Stephanie and Ray Sikes
Permittee Name: Carrizo Stone, LLC
Address: 1425 County Road Q
Pritchett, CO 81064
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
A - 1 4,
Signatur of orporate Officer, Ow %ror Designee
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Date