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flV * RQ--' <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Granby Realty Holdings, LLC ,% RECEIVED <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />M-2006-075 %/ <br />Overlook Mine <br />June 28, 2008 <br />JUN 2 3 '20`,6 ? <br />Division or ' w6amation, <br />Mining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Grand <br />J, /I <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 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 />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 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: _L- ance-Badger - <br />Permittee Name: Granby Realty Holdings, LLC <br />Address: P.O. Box 1110 <br />Phone Number: <br />Fax Number: <br />999 Village Road <br />Granby, CO 80446 <br /> <br />..gWt-92fr3325-- <br />CA-1 0 °- 5 Z ? <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 />A <br />Sign r;orporate Officer, Owner, or Designee <br />7--cg <br />Date