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<br />K ?- W, T-- <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Kagan & Son, L.L.C. Ll? 12i2GI1,W, .T"I <br />PERMIT NO.: M-1994-114 V OCT 0 1 2WJ, <br />OPERATION NAME: Kagan & Son South Pit Division or m tcjamation, YY <br />ANNIVERSARY DATE: October 5, 2008 Mining and Safety ?? <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Custer <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-perfon-ned -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 map are necessary, then no new map 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: Andrew and Rebecca M Kagan <br />Pennittee Name: Kagan & Son, L.L.C. <br />Address: 555 Ernest Ave <br />Westcliffe, CO 81252 <br />Phone Number: (719) 783-0387 <br />Fax Number: (719) 783-3039 <br />If you have additional comments and/or information that should be provided. <br />below or attach it to this form along with your written report and map. Annual <br />Signature o rporate Officer, Owner, or Designee <br />Division, please provide it <br />instructions are enclosed. <br />9?Z9/D g <br />Date