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OIL <br />ANl'QIIfLFEF, an?RT RE VEST <br />PERMITTEE NAME: High Plains Stone Company-North <br />PERMIT NO.: I-1990-016 1 N 0 7 2010 <br />OPERATION NAME: South 40 Quarry Divition of Rsc6-inAiion, <br />ANNIVERSARY DATE: July 11, 2010 Uning and Safety <br />ANNUAL FEE DUE: $$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 coinin 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 year's map are necessary, then nonew 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 />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: SCMrWagner 0Q,bbeA u-r65 "-, <br />Permittee Name: High Plains Stone Company <br />Address: P.O. Box 100 <br />Castle Rock, CO 80104 <br />Phone Number: (303) 791-1862 <br />Fax Number: (303) 791-1919 <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, wner, or Designee <br />,L-1_Jv <br />Date