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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Permittee Contact: Steve Hankins <br />Permittee Name: Hankins Stone Co., Inc. <br />Address: P.O. Box 164 <br />Phone Number: (970) 677 -2909 <br />Fax Number: (970) 677 -2968 <br />Date <br />7--1 -� <br />RECEIVED <br />Cti -' ✓Ju; <br />Hankins Stone Co., Inc. Division of Rol�molin, <br />/ M- 2000 -154 Mining l Sakty <br />c/ <br />Hankins Stone Quarry #1 <br />August 20, 2011 <br />$791.00 (Due on or before your anniversary date) <br />San Miguel <br />Dove Creek, CO 81324 <br />ANNUAL FEE and REPORT REQUEST <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 t eupcoming - year, reclamation that - w lrbe performdcrduring the coming year; the dates far - the lieginning <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 />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 />Signature of Corporate Officer, Owner, or Designee <br />