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JrV` /, fv// PERMITTEE NAME: PERMIT NO.: OPERATION NAME: ANNNERSARY DATE: ANNUAL FEE DUE: COUNTY: /2~~L1/~-~J~~D ~~L ANNUAL FEE and REPORT REQUEST '1'D Mullett Excavating, LLC ~jM-2000-115 Mulletts Excavting Pit # 1 January 24, 2007 ~E~EIVE~ 'DEC ~ :2006 Division of Reclamation, Minmy antl S~;e,y $$688.00 (Due on or before your anniversary date) Las Animas According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, 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 your 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, report, and associated maa. If no new disturbances or reclamation have occurred durinti the previous year 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 suffice for a written report. Division records indicate the following permittee contact information. Please verify and make any necessary changes: Permittee Contact: CF.PR.contact first name CF.PR.contact last name Permittee Name: CF.PR.company_name Address: CF.PR.address 1 CF.PR.city, CF.PRstate CF.PR.zip_code Phone Number: CF.PR.telephone_number Fax Number: If you have additional comments and/or information that should be provided to the Division, please provide 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