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ANNUAL FEE and REPORT REQUEST ?F 1 ® <br />PERMITTEE NAME: Mayne Industries, Inc "/OCT -I ? 2009 <br />PERMIT NO.: M-1987-074 31 Jivisien of reclamation, <br />OPERATION NAME: Dotsero Quarry Mining and Safety <br />ANN VERSARY DATE: October %2,d0`j <br />ANNUAL FEE DUE: TV. )0 (Due on or before your anniversary date) <br />COUNTY: Eagle <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 Lermit; an operator <br />shall-submit the-annual fee, -a report and map showing: the extent of.current disftir bances to affected land, <br />reclamation accomplished to: date-and during the preceding year, new disturbances that-are-ant cipated 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 regort snap to this form The Annual Report <br />Fee requirement is not.rnet until we have received the following components: fee, report, and associated <br />map, If no new disturbances. or reclamation have occur-red during-the previous veal and no new changes to <br />'the previous Year's map are necessary thenno new map 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 />abo e 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: Gerry A. Mayne <br />Petmittee;Name: Mayne Industries, Inc <br />Address: P.O. Box 1689 <br />Gypsum, CO 81637 <br />Phone.-Number: .(970) 524-7733 <br />Fax Number: <br />If. you have.. additional comments and/or information that -should be provided to the Division,: pleaseprovide it <br />below:dr nrrn?h it to this form along with your written reportand map: Annual Report instructions.. are enclosed:.. <br />A <br />, or Designee