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~ ooa <br />P$ItM]TTEE NAME: <br />PERMIT NO.: <br />OPERATION NAMP.: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />/?2~ <br />ANNi1A~iE and REPORT REQUEST <br />~ SW TKO dolnt Venture, I.LC <br />~ M-2004-078 <br />tuptoa Lakes Resource <br />October 17, 2007 <br /> <br />RE~~~~~ED <br />~ OCT 24P00I <br />D+vialon of <br />i/ Mining and ga a°uo+-, <br />$$791.00 (Due oa or before your anniversary date) ty <br />We-d <br />Accorditrxto.C.RS..~2,5=116,oz.C.R,S.~4-~2;~1b,.~h_ yray_~a,lhl~annixe7sary_date.ofSht,permit,;m_opemtc~ .~. <br />shall submit the annual fcc, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and durittg the preceding yr, new disturbances that ere anticipated to occur <br />during the upcoming year, reclamation that will be perforated during the coming yeaz, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your rev)aed written annual renort and annual rcoort man to thts form 1'he Annual Report <br />& Fet requirement is not met until we have received the following components: fee, r ort and associated <br />this to the Annual RenorL Please note that an adequately !abated map chat clearly deltneales and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittc:e contact information. Ylcase verify and make any necessary <br />changes: <br />Permittee Contact: Mark D. Campbell <br />Perntittee Name: SW TKO Joint Venture, LLC <br />Address: 333 W. Hampden Ave, Ste. 810 <br />Englt-evood, CO 80110 <br />Phone Number: (303) 534-1040 <br />Pax Number: (303) 534-6700 <br />1 1 5 CL.. ~ 4d. $ <br />~ron-1(e~~ncra~( rTo~aln~cs l.. <br />5`{bo S.Qw~c.c S'~-..~I to <br />_~reenwoo~ ~•1~ a e CO 80111 <br />303'1"13-IooS <br />303 ~-73-I1~6 <br />If you have additional comments and/or information that should be provided to the Division, please pzovide It <br />below or attach it to this form along with yota written report and map. Amtual Report instructions are enclosed. <br />Signatwc of Corporate Officer, Owner, or Designee <br />/o-~ 3-v~ <br />Date <br />