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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Andesite Rock Company <br />M-1988-048 <br />Carr Gravel Resource <br />September 22, 2003 <br />$688.00 (Due on or before your anniversary date) <br />Weld <br />RECEIVED <br />SEP 17 2003 <br />Division ~f Minerals and Geology <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 />sTia11 su~mrt t e annua ee; as report a`nd map s-meowing the extent o current rstur antes to a ectf~e Tana <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 ynnr revised written anneal reQnrt and anneal re nn rt m ~n 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 Lynn Mayer <br />Permittee Name: Andesite Rock Company <br />Address: 7321 E. 88th Ave., Ste. 200 <br />Henderson, CO 80640 <br />Phone Number: (303) 287656 <br />Fax Number:303)"287 8076 <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 Corp ate Officer, O r, or Desi nee <br />~'I~s/D3 <br />Date ~ <br />M iPERMITMASTERDOCUMENTSUI-AF-01 <br />~3 289 /~3~/~' <br />