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oN;~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rocky Road Investments <br />M-1985-210 <br />Rocky Road Quarry <br />January 27, 2005 <br />~r <br />RECEIVED <br />JAN 2 6 2005 <br />Division of Minerals and Geolosy <br />$688.00 (Due on or before your anniversary date) <br />Latimer <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, 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 anneal re~prt and annual re,Dort m ~n to this form. Pease 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 pemvttee contact information. Please verify and mike any necessary <br />changes: <br />Pemrittee Contact: Douglas J. Bachli <br />Permittee Name: Rocky Road Investments <br />Address: P.O. Box 63 <br />Masonville, CO 80541 <br />Phone Number: (970) 203-1072 <br />Fax Number: (970) 669-8836 <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 thj~ frltm along with yotyjwritten report and map. Annual Report instructions are enclosed. <br />Signature f Co rate Officer, Owner, or Designee <br />v ( ~-~ %-~.s~ <br />Date <br />