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ANNUAL FEE an PORT REOUEST <br />PERMITTEE NAME: Bone Stone, Inc. <br />PERMIT NO.: -2004-030 CIA OPERATION NAME: T Bone Stone Quarry <br />ANNIVERSARY DATE: September 13, 2009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Boulder <br />0 <br />/RECEIVED <br />l xSEP 1: <br />6 . ?Q09 <br />Division oi, i- ;;olamGticn, <br />uil ._ <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 urevious vear's map are necessarv, 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: Bill Tenore <br />Permittee Name: T Bone Stone, Inc. <br />Address: 2337 Emery St <br />Longmont, CO 80501 <br />Phone Number: (303) 324-5021 <br />Fax Number: (303) 776-3839 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />be or a ch it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Owner, or Designee <br />Da <br /> <br />JUC) C'/1 <br />6ve?c-' <br /> <br />M I.G.P-11- <br />,70 3- Vo1 Y/fS'