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MR <br />a~~c~e~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Colorado Lien Company <br />PERMIT NO.: M-1977-002-I3R t/" s~ r3 ~ / <br />OPERATION NAME: Munroe Gypsum Quarry 19 <br />ANNIVERSARY DATE: September 16, 2007 / <br />ANNUAL FEE DUE: $$633.00 (Due on or before your anniversary date) <br />COUNTY: Lorimer <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 <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 upcoming 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 the year, if any. <br />Please attach vour revised written annual report and annual report moo to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous vear and no <br />new chances to the previous year's moo are necessary, then no new man is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Mitch Nachtigall <br />Permittee Name: Colorado Lien Company <br />Address: P.O. Box 440 <br />Rapid City, SD 57709 <br />Phone Number: (605) 342-7224 <br />Fax Number: <br />~,6b5) 3~4 -1246 <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 <br />enclose <br />RECEIVED <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />=/o-off <br />SEP 13 2001 <br />DNlsien of Reclamation, <br />Mining and Safety <br />M:IPERMINIASTBRDOCUMENTS/IN-AF-02.DOC <br />