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o <br />w?? <br />y/01 <br />ANNUAL FEE and REPORT REQUEST r,, ????vm <br />PERMITTEE NAME: Four States Aggregates, LLC JUN <br />PERMIT NO.: M-2001-001 2 3 2008 <br />Division or i-?ecfamation, <br />OPERATION NAME: Line Camp Pit Mining and Safety <br />ANNIVERSARY DATE: June 18, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Montezuma <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 accomplighed-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 map 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 vear's man are necessarv, then no new man 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: Kathy Stone <br />Permittee Name: Four States Aggregates, LLC <br />Address: P.O. Box 1568 <br />Cortez, CO 81321-1568 <br />Phone Number: (970) 565-3388 <br />Fax Number: (970) 565-0276 <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 />- t?5?)?210 N9-- <br />Signature of Corpo to Officer, Owner, or Designee <br />Date