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~ S C~ <br /> ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: C~lorado Lien Company <br />PERMIT NO.: /M-1978-093 <br />OPERATION NAME: Newett Quarry <br />ANNIVERSARY DATE: September 28, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <br /> <br />~sP 222oos <br />~ivisjOn °f Reclamation, <br />Mmm9 and Safety <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 annual resort 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 />maa (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 />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: Shelly Erickson <br />Permittee Name: Colorado Lien Company <br />~~~~n '~oc~~as~~ <br />~~ <br />Address: P.O. Box 440 <br />Rapid City, SD 57709 <br />Phone Number: (605) 342-7224 <br />Fax Number: <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 />/r~ <br />Signature of Corporate Officer, Owner, or Designee <br />/S~a~° <br />Date <br />