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tvl? <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REOUEST <br />fl-Pete Lien and Sons, Inc. <br />klM-1977-304 <br />Rex Quarry - Sec 36 <br />September 26, 2008 <br />C'i4_ <br />fRip'CE RM-0 <br />SEP 18 LU(Md <br />ivision of Keclamation, <br />Mining and Safety <br />$791.00 (Due on or before your anniversary date) <br />Larimer <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 man 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 />SCC) d <br />Permittee Name: Pete Lien and Sons, Inc. <br />Address: P.O. Box 440 <br />Rapid City, SD 57709-0440 <br />Phone Number: (605) 939-2693 <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 f C rporate Officer, Owner, or Designee <br />Date