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js5 <br />~ ANNfiAi, FF.F. and RF,Pt7RT RF.niiF.ST <br />PERMTI'TEE NAME: ,/ Benson Brothers <br />PERMIT NO.: /M-1977-062 ~ MAR 1 ~ 2006 <br />OPERATION NAME: Hallenbeck Pit No 1 /pwision-of Minerals and Geology <br />ANNNERSARY DATE: April 2, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Delta <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 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 yeaz, 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 anm~al re~nrt and annnal report m~ to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the 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: Ed Benson <br />Permittee Name: Benson Brothers <br />Address: 21240 Austin Road <br />Austin, CO 81410 <br />Phone Number: <br />Fax Number: <br />(970)835-3128 <br />(970)835-8567 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~~~~~ <br />Signature of CorpAo_rate Officer, Owner, or Designee <br />~(~/ <br />Date <br />