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bm k <br />it <br />ANNUAL FEE and REPORT REQUEST (;E~VE® <br />~~ <br />PERMITTEE NAME: ~Itanch Land LLC ~ R rz 0 2008 <br />PERMIT NO.: '~M-2003-021 ~ ivision of Reclamation, <br />OPERATION NAME: Ranch Land Rock Pit #2 Mining and Safety <br />ANNIVERSARY DATE: March 22, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />According to C.R.S. 34-3_2.5-116 or C.R.S. 34-32-11.6, 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 vour 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: William Peetz <br />Permittee Name: Ranch Land LLC <br />Address: <br />Phone Number: <br />Fax Number: <br />If you have additi <br />below or attach it t <br />3925 Hill Circle <br />Colorado Springs, CO 80904 <br />(719) 492-0266 <br />(719) 473-5494 <br />comments andlor information that should be provided to the Division, please provide it <br />s form along with your written report and map. Annual Report instructions are enclosed. <br />/ ~ \\ <br />,. ~ ~j,lv / SOU ~ ~~~~ <br />Signature o orporate Officer, Owner, or Designee <br />3~8~D~ <br />Date <br />