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iii iunii~ni~~ ~~i <br />ANNUAL FEE and REPORT REQUEST <br /> <br />R <br />PERMITTEE NAME: <br />PF.,RMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Rocky Road Investments <br />M-1955-210 <br />Rocky Road Quarry <br />January 27, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Larimer <br />JAN ? <br />Divisionaln~:__ <br />,~~® <br />?~~ <br />and ~eploBY <br />According to CR.S. 34-32.5-116 or C.R.S. 34-32-] 16, each year, on the anniversary date o the pentut, an operator <br />shall sttbtnit the annual fee, a report and map showing the extent of current disturb nces to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that re anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the hegittning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach our revised written annual re ort and annual re ort ma to this for Please note drat «n <br />adequately lnbeled map that clearly delineates acrd includes the above elements may since ar u written report. <br />Division records indicate the following permittee contact information. Please verify a make any necessary <br />changes: <br />Permittee 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) fifi9-SS3fi <br />If you have additional comments and/or information that should be provided to the Di <br />below or attach it to this form along with your written report and map. Annual Repnrl inst <br />4~~n <br />Signat of Corporate Officer or Owner <br />S~.,v ~;? ~ r ,boa ~ <br />Date <br />.ion, please provide it <br />aions are enclosed. <br />M:NERM IT1M AS'rrR nOC UM rNTSV.7-A F-01 <br />