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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />Xf ' //d i <br />ANNUAL FEt an REPORT REOUEST <br />Monarch Stone Company <br />WW 4-1991-037 <br />SCE <br />,(A AY 0 3 2010 <br />OPERATION NAME: Katuska Pit Division of Reclamation, <br />Mining & Safety <br />ANNIVERSARY DATE: May 3, 2010 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Park <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 comingyear, 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: Anthony J. Kimmick <br />Permittee Name: Monarch Stone Company <br />Address: P.O. Box 620216 <br />Littleton, CO 80162 <br />Phone Number: (303) 933-9657 <br />Fax Number: (303) 933-2370 <br />Yl- <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 />1 <br />Si nature of Corporate Officer, Owner, or Designee <br />L) -? <br />Date