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Az-,1'7- <br />ANNUAL FEE an PORT REQUEST <br />PERMITTEE NAME: Colorado Lien Company <br />PERMIT NO.: t" M-1977-301 <br />OPERATION NAME: Roberts Quarry <br />ANNIVERSARY DATE: September 22, 2008 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <br /> <br />oo/ <br />SEP I 0 2000 <br />`/" Division or rieclamation, <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 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, riew disturbances that are anticipate 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 may 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 />year's map are necessary, then no new may 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: Mitch Nachtigall <br />CO t? l c?.;n d q u? Y? <br />Permittee Name: Colorado Lien Company <br />Address: 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 along with your written report and map. Annual Report instructions are enclosed. <br />Signature Corporate Officer, Owner, or Designee <br />q/s -a P <br />Date