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/? <br />ANNUAL FEeand RE ORT REQUEST <br />PERMITTEE NAME: ?Arkins Park Stone Corp. <br />PERMIT NO.: A-1981-057 ? RECEIVED <br />OPERATION NAME: Sprague Red Lyons JUN 2 0 2 o i t <br />Division or Kecaamaliaj. <br />ANNIVERSARY DATE: June 10, 2011 Wing and Sol* <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Boulder <br />&k' <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 -accomplishedto_date- and duri .g the preceding ear, 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 vour revised written annual report and annual report may 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: Ju Sprague <br />Permittee Name: r ins Park tone Corp. <br />Address: 5975 NCR 27 <br /> Loveland, CO 80538- <br />Phone Number: (970) 663-1920 <br />Fax Number: (970) 633-2315 <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 />Si ture of rporat Officer, ner, or Designee <br />?1 Z/ X411 <br />? <br />Date / <br />