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III IIIIIIIIIIIII III <br />ANNUAL FEE anti icnrvn. REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Agile Stone Systems, Inc. <br />M-1997-054 <br />Parkdale Project <br />January 11, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Fremont <br />RECEIVED <br />DEC 1 7 2001 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-1 l6 or C.R.S. 34-32-I 16, 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 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. Please note that att <br />adequately labeled mnp that clearly delineates and includes the above elements may st ff ce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact Mark Johnson <br />Permittee Name: Agile Stone Systems, Inc. <br />Address: 31 N. Tejon St. <br />Colorado Springs, CO 80903 <br />Phone Number: (719) 884-8800 <br />Fax Number: (7l9) 884-8801 <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 repots and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer or Owner <br />Date <br />M: WERMnVN/STERDOCUMEfYfSN1~.4F-01 <br />