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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- accomplishedto _date_and, du ring 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 year's map are necessary, then no 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 />above elements may suffice for a written report. <br />AN A FEE and REPORT REQUEST <br />PERMITTEE NAME: 4 Stone Company <br />PERMIT NO.: 4M- 1981 -075 <br />OPERATION NAME: Philips Stone Company <br />ANNIVERSARY DATE: July 30, 2011 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Boulder <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: Phillips Stone Company <br />Address: 7850 Ute Hwy <br />Phone Number: <br />Fax Number: <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 />J/kMl6& (?1y14, <br />Signature of Corporate Officer, 0 <br />Date <br />` 1 ) <br />Longmont, CO 80503 <br />(303) 823 -6395 <br />(303) 485 -2706 <br />er, or Designee <br />yECEV <br />JUL 28 2O1 I <br />+ — division of ;-(eciamation, <br />Mir:ng ar id Safety <br />w,.2, CAL (5_`t )4/ .A0vAt, <br />Zitz we i '' --e44- <br />3 <br />