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yl? <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />? w <br />III. FEE an REPORT REOUEST <br />Acity & County of Denver acting by & thru Bd of Water Comms <br />,v-A-2004-078 <br />Lupton Lakes Resource <br />October 17, 2008 <br />RM Ef HE 'I'D <br />'--0'CT 0 1 2600 <br />$791.00 (Due on or before your anniversary date) Division or r-,eclamation, <br />Mining and Safety <br />Weld <br />o!<? <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 tliaf are anticipated to occur- <br />during the upcoming year, reclamation that will be performed 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 may 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: JoW'az?4 bei Jr <br />John H. 62o <br />Permittee Name: City & County of Denver acting by & thru Bd of Water Comms <br />Address: 1600 W 12th Ave. <br />Denver, CO 80204 <br />4W1 <br />Phone Number: (303) 628-6060 <br />Fax Number: 303 - 626 - (o $$ 1 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />ign ture of Corpora fficer, Owner, or Designee <br />q-3D-08 <br />Date