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4th <br />Lmk <br />PERMITT E NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />f <br />/-T I <br />T REQUEST <br />ANNUAL FEE and REP R1 <br />/Fligh Plains Stone Company <br />-.'_M-1990-016 <br />South 40 Quarry <br />RECD /ICD, <br />--JUN 10 2UU61 <br />J vision of haciamation, <br />Mining and Safety <br />July 11, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />COUNTY: - Fremont <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 your revised written annual report and annual report may to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new may is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Debbie Wagner <br />Permittee Name: High Plains Stone Company <br />Address: P.O. Box 100 <br />Castle Rock, CO 80104-0100 <br />Phone Number: (303) 791-1862 <br />Fax-Number: - --(303) 794--1919 - - ?- - <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 />Signature of Corporate Officer, Mvner, or Designee <br />l.P - Cp ' Oli? <br />Date