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f, ;;z -k R r <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: cam/ Daren Stone <br />PERMIT NO.: M-1997-089 <br />;k9CF-1VF-0 <br />,J JUL 14 2010 <br />OPERATION NAME: Stone Gravel Pit <br />ANNIVERSARY DATE: July 8, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Montezuma <br />Dlvislon of Reclamation, <br />Mining & Safety <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 />r&l-amaticin°accomplished-to-date-and-during-the-precedmg-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 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: Daren R. Stone <br />Permittee Name: <br />Address <br />Daren Stone <br />Cortez, CO 81321 <br />Phone Number:. - <br />Fax Number: (970) 565-0276 <br /> <br />Cin!2) (a5- <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 />Signature of`Corpo ate Officer, Owner, or Designee <br />Date