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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />/'? ` "V -- <br />ANNUAL FEE and REPORT REQUEST <br />`arrizo Stone, LLC <br />r V,-M-2005-067 <br />Carrizo Stone North <br />May 3, 2010 <br />J ?e <br />???p°f p ? 2010 <br />DMWn ct a ' <br />{,Ainivg <br />$$323.00 (Due on or before your anniversary date) <br />Baca <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-tharare-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: Stephanie and Ray Sikes <br />Permittee Name: Carrizo Stone, LLC <br />Address: 1425 County Road Q <br />Pritchett, CO 81064 <br />Phone Number: (719) 643-5325 <br />Fax Number: (719) 643-5327 <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 /> <br />-0,0 /.0 <br />Date