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ANNUAL FEE and REPORT REQUEST , <br />;a <br />PERMITTEE NAME: Lowell Klinglesmith & Lenny Klinglesmith ~%~ y~ <br />PERMIT NO.: M-1978-221 AU~i 2~Z~Q~ ~/ <br />Oivis~on of <br />OPERATION NAME: K-Bar-T Pit M'ain9 and Sa ety on, <br />ANNIVERSARY DATE: August 23, 2007 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <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 />__reclamationaccomplished_to_date and during the preceding_year, new disturbances_that~reanticipaied_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 your revised written annual report 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. If no new disturbances or reclamation have occurred during the previous veer and no new chances to <br />the urevious year's map are necessary, then no new map is required, urovided 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: Lowell Klinglesmith <br />Permittee Name: Lowell Klinglesmith & Leroy Klinglesmith <br />Address: 7576 CR 13 <br />Phone Number: <br />Fax Number: <br />P.O. Box 1164 <br />Meeker, CO 81641 <br />(970)878-4858 <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 />orporate Officer, Owner, or Designee <br />//~~~ v~ 7 <br />Dafe <br />