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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bad Boy Stone <br />M-1992-108 <br />Bad Boy Stone <br />February 3, 2005 <br />$281.00 (Due on or before your anniversary date) <br />Boulder <br />f ~ r~-r <br />Liaision of F`.ineral<F, R~:rf~nr <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 />shall submit the annual fee, a report and map showing the extent of current disturbances to affected ]and, <br />reciama ' ~ .e-Irreeeedirg-y t-arm-antiei~eted-tc~oseur- <br />during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach XQnr revised written anneal rePart and anneal report m sn to Chic 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: <br />Permittee Contact: Pablo Vasquez <br />Permittee Name: Bad Boy Stone <br />Address: 11493 WCR 20 <br />Fort Lupton, CO 80621 <br />Phone Number: (303) 857-4544 <br />- --_Fax Number: -E303j-792~~kB9' <br />Info ne <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 />I <br />Signature of Corporate Offi r, Own r, or Designee <br />~~~05 <br />Date <br />