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<br />(~ ANNUAL FEE and REPORT REQUEST <br />m~i2~ <br />o/-ro-~/ <br />PERMITTEE NAME: ~/Rockbottom, LLC ~ ~ G. E S `~~ <br />PERMTI' NO.: ~/ M-1989-OS4 ,/JAN 10 2001 <br />OPERATION NAME: Oak Creek Gravel Pit <br />ANNIVERSARY DATE: Janua 20 2007 ~ivlslon of Reclamation, <br />r'Y + Mining and Safety <br />ANNUAL FEE DUE: $$688.00 (Dpe on or before your anniversary date) <br />COUNTY: Fremont <br />_ _ _ __According to C.RS. 3432.5-1_1.6 or C.RS. 3432-116 etch year~n,she~nniv~+*YdA*P nfJhe pernut,.p~ ~__ <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upwming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for Ute year, if any. <br />Please attach veer revised written anneal resort and annnal report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated maa H no new disturbances or neclamstion have occprred darinc the previous veer and no <br />new chances to the previous year's map are necesasrv. then no new map ffi reaaired. provided that the <br />Operator shall state this in the Anpnal Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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 />Permittce Contact: Daniel M Russell <br />Permittce Name: Rockbottom, LLC <br />Address: 9042 S. 106 Rd. <br />Alamosa, CO 81101 <br />Phone Number: (719) 587-3630 <br />Fax Number. <br />Tf you have additional comments and/or information that should be provided tb the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report inshnctions are <br />enclosed. <br />Signature of C rporate fficer, Owner, or Designee <br />1Z-3~-off <br />Date <br />M:~P -AF-0O <br />