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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Colorado Alabaster Supply <br />PERMIT NO.: M- 1989 -077 <br />OPERATION NAME: Colo Alabaster <br />ANNIVERSARY DATE: August 28, 2011 <br />ANNUAL FEE DUE: $$86.00 (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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Stanley C. Jones <br />Permittee Name: Colorado Alabaster Supply <br />Address: P 0 Box 548 <br />Phone Number: <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 attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:I PERMIT \MASTERDOCUMENTS /M- AF -02. DOC <br />Fort Collins, CO 80522 -0548 <br />(970) 221 -0723 <br />(970) 221 -0723 <br />