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Iff <br />ANNUAL FEE and REP?ORT REQUEST <br />llips Stone Company <br />PERMITTEE NAME: 1Z1981-075 <br />PERMIT NO.: OPERATION NAME: Phillips Stone Company <br />ANNIVERSARY DATE: July 30, 2009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Boulder <br />W <br />MWENED <br />an 2 4 2009 <br />Divis of Reclamation, <br />49 Mining and Safety <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 ardnm+-fee;--a-report-and -map-showing-the -extent--of-eurrent =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 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 map 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: Robert J. Phillips <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax Number: <br />Phillips Stone Company <br />7850 Ute Hwy <br />Longmont, CO 80503 <br /> <br /> <br /> <br /> <br /> <br />(303) 823-6395 Y-44- Ez <br />(303) 485-2706 <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 Offi er, Owner, r Designee <br />,a 0 9 <br />Date