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~~ 5 ~~ ~`i=a.~1VE <br />ANNUAL FEE and REPORT REQUEST yFEB 12 2007 <br />UiV ion of Reclamation, <br />PERMITTEE NAME:`//Clear Creek District Water Providers, LLC Mining and Safety <br />PERMIT NO.: V M-2004-067 <br />OPERATION NAME: MMRR Quarry <br />ANNNERSARY DATE: February 22, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Gilpin <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-submH-the annual-fee,-a-repcrt and map showing the extent of-current disturbances fo 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 mau to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, resort, and <br />associated mau. If no new disturbances or reclamation have occurred durinc the previous year and no <br />new chances to the previous year's man are necessary, then no new maa is required. provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffece for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Robert A. Lembke <br />Permittee Name: Clear Creek District Water Providers, LLC <br />Address <br />Phone Number: <br />Fax Number: <br />If you have.add <br />below or attacl <br />5460 S. Quebec St., Ste 110 <br />- -- C,reenwood Village, CO-80111 <br />(303)773-1005 <br />(303)773-1176 <br />comments and/or information that should be provided to the Division, please provide it <br />this form along with your written report and map. Annual Report instructions are <br />of Corporate Officer, Owner, <br />Date <br />M:IPERMII\MASTERDOCUMENTSUI-AF-04 <br />