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111 ���I���II��� � <br /> ANNUAL FEE and KEPORT REQUEST <br /> RECEIVED <br /> PERMITTEE NAME: Stone Forge JUN 12 2001 <br /> PERMIT NO.: M-1991-147 <br /> OPERATION NAME: Quinn Quarry Division of Minerals and Geology <br /> II <br /> ANNIVERSARY DATE: July 16,2001 <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: Douglas <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br /> land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated-to <br /> occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br /> beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach your revised written annual report and annual report map to this form. Please note that air <br /> adequately labeled map that clearly delineates and includes the above elements may since for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Jack G. Quinn �U/+0R4 l fhp ATIP4i4E0 . /wPQ.0 <br /> Permittee Name: Stone Forge 3- , Q.&Ud� qMC-'- B WIJ 0l8— <br /> Address: 620 W Henrietta Ave. 19U&6_0t 110101-T-Ell 8 ELLOW <br /> P. O. Box 155 6PP -- dA MI'll?� AS OF _1UP411- <br /> Woodland Park, CO 80866 Zen( . SamE- R io CU mk I� <br /> SAME /3lt + WI41- GF- QoNje 7Y}l$ <br /> Phone Number: (719)687-6869- 087- Q7 �/1=14-i2- <br /> /8 Ly 1 <br /> Fax Number: <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 <br /> enclosed. <br /> Signature of Corporate Officer or Owner <br /> /V& 9 200/ <br /> Date k )-q 9.7 <br /> MAPERM"WASTERDOCUMENTSNI-AF 01 <br />