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<br />AN?FEE and PORT REOUEST <br />REi <br />PERMITTEE NAME: Thornburg Family Limited Partnership <br />PERMIT NO.: PM-1983-060 <br />OPERATION NAME: Thornburg Pit € ?4 e , ? o <br />ANNIVERSARY DATE: September 27, 2010 tv <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <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 accomplishe-l_to date and durin the receding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be perform= during t e coming year, e a i <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: Stanley Thornburg <br />Permittee Name: Thornburg Family Limited Partnership <br />Address: 50747 E. 38 Avenue <br />Bennett, CO 80102 <br />Phone Number: (303) 644-3424 <br />Fax Number: <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 />i <br />1 <br />Signatu e f Corporate Officer, Own6i, or Designee <br />Date