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es~ <br />PERMiTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Pet Lien and Sons, Inc. <br />~i14I-1977-304 <br />Rex Quarry -Sec 36 <br />September 26, 2006 <br />i~-~ <br />221006 <br />Dlvlslon or <br />Mining and Sa efy°n, <br />$688.00 (Due on or before your anniversary date) <br />Larimer <br />According to C.R.S. 34-32.5-1 16 or C.R.S. 34-32-1 16, each year, on the anniversary date of the permit, an operator <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 vour revised written annual reooM and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map (All are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Shelly Erickson <br />Permittee Name: Pete Lien and Sons, Inc. <br />Address: P.O. Box 440 <br />Rapid City, SD 57709-0440 <br />Phone Number: (605) 939-2693 <br />Fax Number: <br />\~ ~ch~\A0.\~ <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 instructions are enclosed. <br />~~i,~/i,~=~,- <br />Signature of Corporate Officer, Owner, or Designee <br />y /s-a(9 <br />Date <br />