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Al? *_ Kirr <br /> ANNUAL FEE and REPORT REOUEST <br /> ? <br />PERMITTEE NAME: Quikrete Materials, LLC p Vgyp <br />PERMIT NO.: M-1987-028 ? FE3 22011 <br />OPERATION NAME: Lily Mines <br /> Division of Reclamation, <br />ANNIVERSARY DATE: March 18, 2011 ? Mining and Safety <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <br /> <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 reauired. 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: Wi Magill <br />ice ? i ? ??Io b ? <br />Permittee Name: Quikrete Materials, LL M A'Teat,,g LS, L L L <br />Address: 3490 Piedment R ., Suite 1300 y 1 (! eSm osrT- 12 o * d <br />S V i7e [ SO O <br />Atlant A 30305 - <br />Phone Number: (404) 634-9100 q 0 L/ ^ 63q-1 l on <br />Fax Number: (678) 417-4700 q09 - 8 t{ j ^ 0 1 <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/L'-? ?it-fl <br />Signature of Corporate Officer, Owner, or Designee <br />2 -IC-// <br />Date