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III IIIIIIIIIIIIIIII <br />ANNUAL FEE and REPORT REQUEST <br /> <br />RECEIVE® <br />PERMITTEE NAME: H & H Stone <br />PERMIT NO.: M-1998-080 NOV 13.2001 <br />OPERATION NAME: H & H Quarry #Z Oivisian of Minerals and Geology <br />ANNIVERSARY DATE: November 27, 2001 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Dolores <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 submi[_ the annual fee, a report and- map_ showing_the extent-of_currenr disturbances-to-affected. land,- <br />reclama[ion accomplished [o 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 vour revised written annual report and annual resort maa to this form. Please note that m7 <br />adequately labeled map that clearly delineates and includes the above elements Wray since for a written report. <br />Division records indicate [he following permittee contact infornation. Please verify and make any necessary <br />changes: <br />Permittee Contact: Fred Holley <br />Permittee Name: H & H Stone <br />Address: P.O. Box 162 <br />Dove Creek, CO 81324 <br />Phone Number: (970) 677-2767 <br />Fax Number: (970) 677-2921 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach i[ to [his form along with your written report and map. Annual Report instructions are enclosed. <br />~ ~~ n <br />Signature of Corp rate Officer or Owner <br />~'~~ ~~ <br />Date <br />At: W ERA11TU1ASTERD000MENTSU1-AF-01 <br />