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~ i~ f ~~j <br />ANNUAL FEE and REPORT REpUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Colorado Rose Red Corporation <br />'~M-1978-332 <br />Colorado Rose Red Pit <br />October 23, 2007 <br />RECFivFp <br />-OCT ~ ~ 1001 <br />~brlelon of ReolsmNion, <br />Mining and BNOty <br />$$323.00 (Due on or before your anniversary date) <br />Larimer <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 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, reuort, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new chances to <br />the previous year's map are necessary, then no new man is required, arovided 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Daniel J. Liesveld <br />Permittee Name: Colorado Rose Red Corporation <br />Address: 148 Cheyenne Ct. <br />Lyons, CO 80540 <br />~ o C_ 6t~7.tC~~i Awa <br />~.~C.,t._f~.u2A770~7 LS too % Ll>Fs~1:.L> <br />t/P ff'r /KL _~rI%>~ <br />Phone Number: (303) 823-6023 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this form along with your written report and map. Annual Report instmctions are enclosed. <br />~a~,0 <br />Signature o orporate Officer, Owner, or Designee <br />//J- ~ ~ ~ <br />Date <br />