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r4?ic.- R? <br />ANNUAL FEE and REPORT RE UEST <br />PERMITTEE NAME: Moffat Limestone Company <br />PERMIT NO.: ", VM-1982-141 <br />OPERATION NAME: Juniper Quarry <br />ANNIVERSARY DATE: August 9, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <br />ki,-Z - ,;.4. <br />?,-' AUG 0 6 2010 <br />I Div4ian csf R=aarr,*Oon, <br />+finimj arid 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 />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 mat) 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 may are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual_Reyort. 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: Darryl Steele <br />Permittee Name: Moffat Limestone Company <br />Address: 62207 US Hwy 40 <br />P.O. Box 205 <br />Maybell, CO 81640 <br />Phone Number: (970) 272-3215 <br />Fax Number: (970) 272-3215 <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 />&4/ <br />Signature Corporate Officer, Owner, or Designee <br />g-G/-12kz) <br />Date