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III �II�II�II��II �II <br /> sss <br /> ANNUAL FEE and REPORT REQUEST d <br /> RE\rEe:. `rC` <br /> PERMITTEE NAME: Andesite Rock Company 5EP 2 <br /> PERMIT NO.: M-1988-048 <br /> OPERATION NAME: Carr Gravel Resource Division of Minerals and Geology <br /> ANNIVERSARY DATE: September 22, 2001 <br /> ANNUAL FEE DUE: $688.00(Due on or before your anniversary date) <br /> COUNTY: Weld <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 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 an <br /> adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: / r <br /> Permittee Contact: Lynn Mayer ! <br /> Permittee Name: Andesite Rock Company <br /> Address: 7321 E. 88th Ave., Ste. 200 �Q <br /> Henderson, CO 80640 <br /> Phone Number: (303) 287-4656 <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 ' o this form along with your written report and map. Annual Report instructions are enclosed. <br /> Signatur f Co o to Of ice <br /> or Owner <br /> Date <br /> M:\PERMrM7ASTERDOCUMENTSNI-AF 01 <br />