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ojr A- R PT <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE VEST <br />Daren Stone <br />M-1997-089 &/ <br />Stone Gravel Pit <br />July 8, 2009 <br />$791.00 (Due on or before your anniversary date) <br />Montezuma <br />iv <br />? JUN 2 4 2009 <br />511MMgm of Reclamation, <br />Mining 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-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 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: Daren R. Stone <br />Permittee Name: Daren Stone <br />P.O. Box-W3- <br />Address: <br />Cortez, CO 81321 <br />Phone Number: 03 <br />Fax Number: (970) 565-0276 <br />`-? c?5 ? k 1 E>La <br /> <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 />Signature of Corporate Officer, Owner, or Designee <br />cI?oc? <br />Date