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i <br />r. <br />PERM ITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />L FEE and REPORT REQUEST <br />ANN <br />V Colorado Quarry I, LLC <br />V/M-2009-006 <br />Meadow Hollow Quarry <br />February 27, 2011 <br />$$323.00 (Due on or before your anniversary date) <br />Larimer <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 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: John E. Holliday <br />Pennittee Name: Colorado Quarry 1, LLC <br />Address: 225 S.W. 42nd Street. Unit C <br />Loveland, CO 80537 <br />Phone Number: (970) 567-7388 <br />Fax Number: (866) 707-9804 <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 />/v `CINA i ?t.« b?? <br />;SoioO?e of Corporate Officer, Owne , or esignee <br />p 2 - Z3 - ZaLN <br />Date