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FA i--' -?- 2PT <br />ANNUAL FEE and REPORT REOUEST <br />-01 <br />PERMITTEE NAME: Colorado Lien Company vfiil' <br />PERMIT NO.: M-1978-093 t/ <br />OPERATION NAME: Newett Quarry <br />ANNIVERSARY DATE: September 28, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Chaffee <br />RECE ED <br />SEP I d [0od c? <br />Division or rieclamation, . ?/ <br />Kning 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 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 may. If no <br />new disturbances or reclamation have occurred during the previous year and no new chances to the previous <br />vear's map are necessarv, then no new man 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 />Shelly Erickson <br />Leo ?4 Lc?.x?cA q u?r <br />Colorado Lien Company <br />P.O. Box 440 <br />Rapid City, SD 57709 <br />Phone Number: (605) 342-7224 <br />Fax Number: <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 ong with your written report and map. Annual Report instructions are enclosed. <br />Signature o Corporate Officer, Owner, or Designee <br />Pr-ot <br />Date