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<br /> F <br /> ANNUAL <br />EE and REPORT REQUEST <br /> <br />PERMITTEE NAME: Rocky Road Investments <br />PERMIT NO.: ;/ I-1985-210 <br />OPERATION NAME: Rocky Road Quarry <br />ANNIVERSARY DATE: January 27, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <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 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: Douglas J. Bachli <br />Permittee Name: Rocky Road Investments <br />Address: P.O. Box 63 <br />Phone Number: <br />Fax Number: <br />Masonville, CO 80541 <br />(9701203-1072 <br />(970) 669-8836 <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 firm along with your written report and map. Annual Report instructions are enclosed. <br />(Doze, <br />Signatklre of )rporate Officer, Owner, or Designee <br />Date <br />f tECEWF-n <br />JAN 2 6 2011 <br />Division of hteGWnWjor,, <br />Mining and Safety