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D lG-- <br />ERMITTEE NAME: <br />/ (? " /? ? r <br />4 <br />ANNU L FE an REPORT REOUEST <br />RED^,MV <br />JUN 0 4 2008 <br />i Nvision or heciamation, <br />Mining and Safety <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />-Caldwell Brothers <br />/M-1986-016 <br />Caldwell Brothers 3 <br />June 1, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Otero <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 yea,-rec aml`afion`thatwili7b`e rfonn- d=dut?i: g 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 may are necessary, then no new may 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: Wayne Caldwell <br />Permittee Name: Caldwell Brothers <br />Address: 25026 Rd 19 <br />Rocky Ford, CO 81067 - - <br />Phone Number: (719) 254-3210 <br />Fax Number: <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 />Signa a of Corporate Officer, Owner, or Designee <br />S- 3v ooh <br />Date