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;A.L FEE and REPORT REOUEST <br />PERMITTEE NAME: ✓Moffat Limestone .-ornn= -_ <br />PERMIT NO.: ✓M - 1982 - 141 <br />OPERATION NAME: Juniper Quarry <br />ANNIVERSARY DATE: August 9, 2011 <br />ANNUAL FEE DUE: S791.00 (Due on or before your anniversary date) <br />COUNTY: Moffat <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 />snail submit the annuai fee, a report and map snowing the extent of current disturbances to affected land, <br />-cciamation 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 beginninn <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: Darryl Steele <br />Permittee Name: Moffat Limestone Company <br />Address: 62207 US Hwy 40 <br />P.O. Box 205 <br />Maybell, CO 81640 <br />Phone Number: (970) 272 -3215 <br />Fax Number: (970) 272 -3215 <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 ofit 3rporate Officer, Owner, or Designee <br />7 -4 9 -// <br />Date <br />Plc <br />RECEIVED <br />' JUL 2 2 2011 <br />Division of Reclamation, <br />Mining & Safety <br />