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ol< <br />WQ- <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Rockbottom, LLC oC r 0 0 200$ <br />PERMIT NO.: M-1979-192 CTM J ?OPERATION NAME: Spotted Burro Pit <br />ANNIVERSARY DATE: October 14, 2008 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <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 perforneddurirfg 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 may 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: <br />JQEE a2effiL <br />Permittee Name: Rockbottom, LLC <br />S???` <br />Address: o0? <br />.??-F -J o <br />?(. 9 c ra ?8? C 00 77 <br />C 1'a r? o??n? <br />Phone Number: (449)-5-33=21 6 q lq -?-,I o `"- ` Q 2- <br />Fax Number: - W - -6-Y3 -07 6 8 <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 0417111 along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corpor'dte Officer, Owner, esignei <br />Date