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ANNIIAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMTf NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />R'illits Company, Inc. <br />M-2004-017 <br />Kattenberg Pit <br />July 1, 2006 <br />$688.00 (Due on or before your anniversary date) <br />Grand <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following petmittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Bob Willits <br />Permittee Name: Willits Company, Inc. <br />Address: P.O. Box 825 <br />Cheyenne, WY 82003 <br />Phone Number: (307) 634-2300 <br />Fax Number: (307) 634-2310 <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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMITVNASTERDOCUMENTSVd-AF-04 <br />