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PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNNERSARY DATE ANNUAL FEE DUE: COUNTY: Haldorson and Sons, Inc. M-1995-038 Spor Pit October 30, 2006 $281.00 (Due on or before your anniversary date) San Miguel 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 _ shall submit the annual fee~a report and map showin the extent of current disturbances to affected lan_ d,,_ ___ reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and the date active operations ceased for the year, if any. Please attach vour revised written annual report and annual report map to this form. The Annual Report & Fee requirement is not met until we have received the following components: fee, resort, and associated maa. If no new disturbances or reclamation have occurred durinti the previous vear and no new chanties to the previous year's map are necessary, then no new map is required, provided that the Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may since for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: Mark S. Haldorson Permittee Name: Haldorson and Sons, Inc. Address: P.O. Box 1019 Montrose, CO 81402 Phone Number: (970) 209-1933 Fax Number: If you have additional comments and/or information that should be provided to the Division, please provide it below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. Signature of Corporate Officer, Owner, or Designee Date