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W * Rf' <br /> ANNUAL FEE and REPORT REQUEST <br /> VO <br />PERMITTEE NAME: Colorado Lien Company <br />PERMIT NO.: M-1985-038 ? <br />OPERATION NAME: Rifle Quarry <br />ANNIVERSARY DATE: September 26, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <br />RECENEC' <br />SEP 1 ? ?u?,,: ? <br />Division of Kaclamation, M <br />Mining and Safety c/ <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 shall <br />submit the annual fee, a report and map showing the extent of current disturbances to affected land, reclamation <br />- -accomplished to-date-and-during the preceding year,-new disturbances that-are-anticipated-to-occur during-the upcoming <br />year, reclamation that will be performed during the coming year, the dates for the beginning of active operations, and <br />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 & Fee <br />requirement is not met until we have received the following components: fee, report, and associated map. If no <br />new disturbances or reclamation have occurred during the previous year and no new changes to the previous <br />vear's map are necessarv. then no new map is required, provided that the Operator shall state this in the Annual <br />Report. Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary changes: <br />Permittee Contact: <br />Permittee Name: <br />Address: <br />Mitch Nachtigall <br />?co k-LG_f)aQ h <br />Colorado Lien Company <br />P.O. Box 440 <br />Rapid City, SD 57709 <br />Phone Number: (605) 342-7224 <br />Fax Number: (605) 394-7246 <br />If you have additional comments and/or information that should be provided to the Division, please provide it below or <br />attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature o Co orate Officer, Owner, or Designee <br />Date