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<br />ae S ,--> r/- <br />A jr-, ?- AP 7- <br />ANNUAL FEE and REPORT RE UEST <br />E IEVVED <br />PERMITTEE NAME: ?Nkins Park Stone Corp. <br />PERMIT NO.: ? -1981-057 JU?9 i?' <br />OPERATION NAME: Sprague Red Lyons Division of Reclamation, <br />Mining & 5afoty <br />ANNIVERSARY DATE: June 10, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Boulder <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- e performed during the coming year, t e ates or a egmnmg <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 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: Judy Sprague <br />Permittee Name: Arkins Park Stone Corp. <br />Address: 5975 NCR 27 <br />Loveland, CO 80538 <br />Phone Number: (970) 663-1920 <br />Fax Number: (970) 633-2315 <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 />Si a ure of Co porate ficer, Ow her, or Designee <br />Date