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~~ ~- R~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Mesa Sandstone, LLC r ~~t:~~~ <br />PERMIT NO.: M-2006-009 APR 0 ~+ 20U8 l/ ~ <br />OPERATION NAME: 13indmarsh Sandstone ' / <br />Division of Keciamation, IV% <br />ANNIVERSARY DATE: April 28, 2008 Mining and Safety <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Montezuma <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 our revised written annual re ort and annual re ort ma to this or Annual Report <br />F requirement is not met until we have received the following components: a re ort and associated <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since 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 K. Goode <br />Permittee Name: Mesa Sandstone, LLC <br />Address: P.O. Box 220 <br />Cortez, CO 81321 <br />~ ~~p~ <br />Phone Number: (970) 565-1167 <br />Fax Number: (970) 565-1167 <br />If you have additional comments and/or information that sho d 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 />x <br />Signature of CorJporate Officer, caner, or Designee <br />7 ~~ <br />Date <br />