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oK <br />ANNdAL FEE''nd RE?1' KE UEST <br />?ZBI 'RECEIVED <br />PERMITTEE NAME: a Mountain Stone <br />PERMIT NO.: 1981-108 UG 3 i 2009 <br />OPERATION NAME: Beech Hill Quarries Division of Reclamation, <br />.?-D Mining and Safety <br />ANNIVERSARY DATE: August 29, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <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 />- - -reclamat-ion-ace©mplished-to-date-and_during-the_preceding-year,-ne_w. _di_sturbances 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 vour 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 vear'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: Abe Vasquez <br />Permittee Name: Blue Mountain Stone <br />Address: 4168 Ute Hwy <br />Longmont, CO 80503 <br />Phone Number: (303) 823-9625 <br />Fax Number: (303) 823-6888 <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 />Corporate Officer, Owner, or Designee <br />?2 <br />Date <br />