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03-OCT-2005 11:14 FROM-Colorado Division at Minerals 8 Geology +13038328106 <br />PERMTI"I'EE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />9f,=~;'~ <br />~nch Land, LLC <br />~/M-2002-096 <br />Ranch Land Rock kit #1 <br />OMOber 15, 2005 <br />T-T51 P.002/002 F-507 <br />hhP~ <br />RECE~ VED <br />`~OCT~y~ <br />vision of Minerals and Ceolagy <br />$68g.00 {Doc on or before your anniversary date) <br />Fremont <br />According to C.R.S. 3432.5-116 ar C.RS_ 34-32-1 I6, each year, on the anniversary date of the pernrit, an operetor <br />shall submit the atmual 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 ttpcoming year, reclamation that will be performed during the coming year, the dates for the bebimring <br />of active operations, and the date active operations ceased for the year, if any. <br />Please artarh ynnr revised writ(pn annnat report and ann r 1 rennet map to tnic fnrm_ please ante that an <br />adequately labeled map that clearly delineates and includes the above elements logy since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Petmittee Contact: William Peeta <br />Petmittee Name: Ranch Land, LLC <br />Address: 3925 hill Circle <br />Colorado Spring, CO 80904 <br />Phone Number: (719) 492-0266 <br />Fax Number: (719) 473-5494 <br />If you have additional comments and(or information that should f>e provided to the Division, please provide it <br />below or attach it to this fmm alottg with your written report and map. Atmual Report instntctions are enclosed. <br />Signature of Corporate O c ,Owner, or esignee <br />a~/?-~~ ~ <br />