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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Gr I <br />AN FEE and PORT REQUEST <br />j'k/ rkland Construction, RLLP <br />:'M-1998-038 <br />Two Rivers <br />August 3, 2008 <br />$$791.00 (Due on or before your anniversary date) <br />Pueblo <br />t A4 )? <br />RECEIVED <br />0 4 2003 <br />Division of Reclamation, <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, 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 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: Joe C. Baxter <br />Ct <br />Permittee Name: K land Construction, RLLP <br />Address: P.O. Box 580 <br />2101 Main Street <br />Rye, CO 81069 <br />Phone Number: (719) 489-3385 <br />Fax Number: (719) 489-2265 <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 />- Qd?- C' - <br />S' ature of Corporate Officer, Owner, or Designee <br />I- --- 7 ? <br />Date