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~,~~! <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: iI{agan & Son, L.L.C. RECE~VE~ <br />PERMIT NO.: i-M-1994-114 -SEP 26 2007 <br />OPERATION NAME: Kagan & Son South Pit <br />D~1elon of Reclamation, <br />ANNIVERSARY DATE: October 5, 2007 ./ Mlnlnp end Safety <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Custer <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 pernut, 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 reuort and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the fallowing components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the urevious year's map are necessary, then no new mau is required, provided 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 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: Andrew and Rebecca M Kagan <br />Permittee Name: Kagan & Son, L.L.C. <br />Address: 555 Emest Ave <br />- Westcliffe, CO 81252 <br />Phone Number: Fr'-1~9j~93 29~' ~~~9~ ~~ 3 - /~~ 3.~, <br />Fax Number. ~7/9~ /9L/ - 03013/ <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 />ignature of Cq to Officer, Owner, or Designee <br />r1~Z~-f,O7 <br />Da~ <br />