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<br />~~ ~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Loukonen Bros. Stone <br />M-2000-090 <br />Lykins Gulch <br />February 1, 2005 <br />JAi~J 2 ~: ~~~5 <br />flivisign of Minerals ~ peglgpy <br />$281.00 (Due on or before your anniversary date) <br />Boulder <br />According to C.R.S. 34-32.5-116 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 />reciamaticm-accomplished-to-date-and-during-the-preceding_year,~aw_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 yonr revised written anmral refit and anmral re~nrF main to this form. Please note that an <br />adequately labeled map that clearly 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: Michael Loukonen <br />Permittee Name: Loukonen Bros. Stone <br />Address: 12993 N. Foothills Hwy. <br />Phone Number: <br />Fax Number: <br />Longmont, CO 80503 <br />(303)823-6268 <br />(303)823-0843 <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 Corpor e~er, Owner, or Designee <br />~~~~/ ~O 5 <br />Date <br />