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9---_ <br /> C <br />yf I <br /> AN-NAL FEE and PORT REQUEST <br /> <br />PERMITTEE NAME: ( <br />cam Stone LLP <br />PERMIT NO.: i? <br />007-050 <br />OPERATION NAME: Buffalo Stone Quarry <br />ANNIVERSARY DATE: March 4, 2011 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Las Animas <br />MAR 07 2011 <br />of Redamawn, <br />p ivisit?oi nning S Safely <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--ftles forte-begirifring <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 vear's map are necessarv, 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: Dale Yocam <br />Permittee Name: Yocam Stone LLP <br />Address: 35600 County Road 215.5 <br />Kim, CO 81049 <br />Phone Number: (719) 980-5107 <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 attacrm along with your written report and map. Annual Report instructions are enclosed. <br />0Signature o <br />f Corporate Officer, Owner, or Designee <br />Date