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,~c~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Carder, Inc. <br />~ <br />PERMIT NO.: / <br />,/ M-2003-052 <br />OPERATION NAME: Windy Ridge Pit <br />ANNIVERSARY DATE: September 2, 2006 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <br />~~ <br />q-~~~~ <br />RF~,~„ ~~ <br />/~A~O 312006 <br />uivisioq °f <br />Minins aRd Sate~y'Op- <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 l6, each year, on the anniversary date of the permit, an operator <br />-hall cnhmir th annual f P •~eonrt_and.mapshotving the extent of_cunent disturbances-to affected-3and, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated [o occur <br />during 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 maa to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, resort, and associated <br />map (All are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />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: Ron Peterson <br />Permittee Name: Carder, [nc. <br />Address: POB 732 <br />Phone Number: <br />Lamar, CO S 1052 <br />(719)336-3479 <br />Fax Number: (719) 336-0196 <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 />Signature of ~orporate ffic~r, Owner, or Designee <br />~d ~ ~ <br />Date <br />