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~,~ ~ RP-~ <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST ~/ <br />~~% <br />Hilltop Aquatic In/vestments, LLC <br />M-2004-022 ~/ <br />Raindance Sand and Gravel Mine <br />March 4, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Weld <br />RE~E~VED <br />FEB 2 9 2008 ~ <br />Division of Fteciamation, t% <br />Mining and Safety <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 />.:-~ra.~sphpall s~u}bm~it~the annuaAl fee, a report and map showing the extent of current disturbances to affected land, <br />..~-~...~_.._. 1,iV1~0. 1V1 LL~~~~~a .,.. .a~_-.~ •7~.]. li~fil Ja~.~-_.~..o v~xo _ - 9rP anti ~ ~ .. _ _ _~ <br />1 l 1 1 S __ i_ _.=Q - Y.~~. ..a J....., . !`7119 <br />~vw~dist~a~Ees-that- ~. tecLtc~nccur_ <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 man 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: Martin Lind <br />Permittee Name: Hilltop Aquatic Investments, LLC <br />Address: 1625 Pelican Lakes Pt., Ste. 201 <br />Windsor, CO 80550 <br />Phone Number: (970) 686-5828 <br />Fax Number: <br />l~ u~~ ~(J~~B~}ncc~S or`~ <br />~~~t yRVC oc~ccP,Q~ <br />l7lt ff' /n!~ 2007. <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 />~ ai ~ ~- ,t~~Na~~ <br />Si ature of orporate Officer, Owner, or Designee <br />2- Z~--O~ <br />Date <br />