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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Permittee Contact: Bill Tenore <br />Permittee Name: <br />Address: <br />Phone Number: ( 3 ' " = <br />Fax Number: (303) 776 -3839 <br />Date <br />J <br />AN L FEE and REPOR /RE Q UEST <br />T Bone Stone, Inc. <br />2337 Emery St <br />Longmont, CO 80501 <br />1 <br />one Stone, Inc. <br />- 2004 -030 <br />T Bone Stone Quarry <br />September 13, 2011 <br />$$323.00 (Due on or before your anniversary date) <br />Boulder <br />ECCN <br />SEp 19 2011 <br />ivision of Reclamation, <br />Mining and Safety <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 />reclauiatiou accomplished -to- date- and - during- the - preceding ear ,_n_ew 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 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 />30 (is <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 • . • ng with your written report and map. Annual Report instructions are enclosed. <br />1 �of Cor orate Officer, Owner, or Designee <br />