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l~ <br />r <br />dmk <br />ANNLJAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANN-UAL FEE DUE: <br />COUNTY: <br />`/Ranch Land LLC <br />J M-2003-021 <br />Ranch Land Rock Pit #2 <br />March 22, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <br />`~~E'D <br />MAR 212008 <br />J~'v~a~on c~ ~ec-amation, <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 />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-distur-banees 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 man to this form The Annual Report <br />& Fee regmrement is not met until we have received the following components: fee, report, and associated <br />man. If no new disturbances or reclamation have occurred durin the revious ear and no new Chan es to <br />the previous year's man are necessary then no new man is required provided that the Operator shall state <br />this m the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffrce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Willia~tz <br />Permittee Name: Ranch Land LLC <br />Address: 3925 Hill Circle <br />Colorado Springs, CO 80904 <br />Phone Number: (719) 492-0266 <br />Fax Number: (719) 473-5494 <br />If you have additi <br />below or attach it t <br />comments and/or information that should be provided to the Division, please provide it <br />form along with your written report and map. Annual Report instructions are enclosed. <br />i <br />Signature <br />Officer, Owner, or Designee <br />~ ~~~ <br />3~8/0~ <br />Date <br />