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~%~ ~~~~i <br />ANNiJAL FEE and REPORT REQUEST <br />PERMITTEE NAME: American Gypsum Company LLC Q 4~r~ <br />PERMIT NO.: ~M-1984-041 ~~~C ®g 2oQ] <br />OPERATION NAME: Eagle-Gypsum Mine ~~ 'sion or° Reclamation <br />Mining and Safety <br />ANNIVERSARY DATE: December 24, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Eagle <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 />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />_ reclamation accomplished to date and_ during the preceding_year, new disturbances that are anticipated to_ 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 your 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 />map. If no new disturbances or reclamation have occurred during the previous year and no new changes 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Stephen A. Onorofskie <br />Permittee Name: American Gypsum Company LLC <br />Address: 740 Hwy 6 <br />Gypsum, CO 87637 <br />Phone Number: (970) 524-9700 <br />Fax Number: <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 fo along with your written report and map. Annual Report instructions are enclosed. <br />Signatur of Co orate Officer, Owner, or Designee <br />lT9 /~ <br />Date <br />