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ANNiiAi, FF.F, and RFPnRT RF,nfiF.ST RECEIVED <br />PERMITTEE NAME: J And K Limestone Products, LLC. ~~ ~ 8' 2004 <br />PERMIT NO.: M-2000-116 Division of Minerals & Geology <br />OPERATION NAME: J and K Limestone Products-Villa Grove Pit <br />ANNIVERSARY DATE: January 24, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Saguache <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 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,~nur revised written annual rennrt and annual reRnrt m~ 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: Jim Willschau <br />Pertnittee Name: J And K Limestone Products, LLC. <br />Address: 1410 CR 2 E. <br />Monte Vista, CO 81144 <br />Phone Number: (719) 852-2760 <br />Fax Number: (719) 852-2685 <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 />Sig tore of Corporate Officer, Owner, or Destgnee <br />/~~~-O,~ <br />Date <br />M:~PERM ITVv1ASTERDOCUM ENTSVA-AF-01 <br />