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ANNUAL FEE a d P~RT~RE VEST <br />O <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Robins Construction Co. LLLP <br />~M-2002-014 <br />Robins Pit No. 1 <br />May 16, 2008 <br />$$323.00 (Due on or before your anniversary date) <br />Conejos <br />~~~~~~~® <br />MAY '~ 3 2008 <br /> <br />~Oivision or rieclamation, <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 disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year~h`e"dates-for tke=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 />man. 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: Randy Robins <br />Permittee Name: Robins Construction Co. LLLP <br />Address: P.O. Box 212 <br />Antonito, CO 81120 <br />Phone Number: (719) 376-2351 <br />Fax Number: (719) 376-2651 <br />~tQWrjP `r S' _ u Ga l' S'_ <br />1~.~ . <br />If you have additional comments andlor 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 />~~.~ <br />Si ature of Corporate Officer, Owner, or Designee <br />~ ~ <br />Date <br />