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<br />PERMfTTEE NAME: v SW TKO Joint Venture, LLC ~ ECEIl~Ep <br />PERMIT NO.: // M-2004-078 ~f :j ~ ~ ~(~~~ <br />OPERATION NAME: ~ Lupton Lakes Resource Division of Reclamation, <br />Mining and Safety <br />ANNIVERSARY DATE: October 17, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your amlversary date) <br />COUNTY: Weld <br />eYI~j~L-- <br />~~ l3 -G,G <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 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 />Pease attach vour revised written annum 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 durinti the previous veer and no new chanties to <br />the previous year's map are necessary, then no new map is repaired. provided that the Operator shall state <br />this in the Auuual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Mark D. Campbell <br />/DIy / <br />Pemrittee Name: SW TKO Joint V~' nture, LLC <br />Address: 333 W. Hampden Ave, Ste. 810 <br />Englewood, CO 80110 <br />Phone Number. (303) 534-1040 <br />Fax Number: (303) 534-6700 <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 />Signature of Corpo a Officer, Owner, or Designee <br />~ Jf zi~O ~ <br />Date <br />