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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Hall-Irwin Corporation <br />M-1998-013 <br />The Shores <br />October 1, 2006 <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 yeaz, on the anniversary date of the permit, an <br />operator shall submit the annual fee, a report and map showing the extent of cun•ent distwbances to affected <br />land, reclamation accomplished to date and during the preceding year, new distwbances that are anticipated to <br />occur dwing the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised writteu annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, resort, and <br />associated map. If no new disturbances or reclamation have occurred durine the previous vear and no <br />Oaerator shall state this in the Annual Report. Please note that an <br />delineates and includes the above elements may suffice for a written report. <br />map <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Jeff Gregg <br />Hall-Irwin Corporation <br />301 Centennial Dr. <br />Milliken, CO 80543 <br />Phone Number: (970) 587-7279 <br />Fax Number: (970) 587-7289 <br />If you have additiona- 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 aze enclosed. <br />Signature of Corporate Officer or Owner <br />Date <br />