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~ ~ ~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Hilltop Aquatic Investments, LLC <br />~M-2004-022 <br />Raindance Sand and Gravel Mine <br />March 4, 2007 <br />RF~F~~~D <br />ot~;SOEB 2820p7 <br />r'~tpg aR Sa ration <br />ty <br />$$688.00 (Due on or before your anniversary date) <br />Weld <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 />`-`sttall'submit-the' annual fee; a ieport and'map showing the extent-of-currenf 3isturbances to affecfed-land, <br />-` reclaiitatiori accomplished to date and during the preceding year, new distorbances that ai'e anticipated'fo occur - <br />dunng 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 vour 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 />man. If no new disturbances or reclamation have occurred durinti the previous vear and no new chanties to <br />the previous year's map are necessary, then no new map is required, provided 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 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: Martin Lind <br />~~c4tand Cohnell <br />Permittee Name: Hilltop Aquatic Investments, LLC Crnne\1 ~evouve~.n ~ Znc <br />Address: 1625 Pelican Lakes Pt, Ste. 201 X305 Ens+ {-4avmowv~d <br />Windsor, CO 80550 ~n~+ ColUns, Gtr ~ZS <br />Phone Number: (970} 686-5828 ~Q~Old~3-3t51 <br />Fax Number: [q~01 Z 2 3- 3 i k J <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 />"~J\ ' ~1~ <br />Signature of Corporate i er, Owner, or Designee <br />Date <br />