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0M C <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REP T REQUEST <br />kolorado Rose Red Corporation <br />v(W-1978-332 <br />Colorado Rose Red Pit <br />October 23, 2008 <br /> <br />46 1 r, LU") <br />Division 0",-',;c10n1@tion, <br />_?Ol,ining and Safety <br />$323.00 (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 <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-antieipated-to-oseur -- >-- <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 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: Daniel J. Liesveld <br />Permittee Name: Colorado Rose Red Corporation <br />Address: 148 Cheyenne Ct <br />Lyons, CO 80540 <br />Phone Number: (303) 823-6023 <br />Fax Number: <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 />Signature of Corporate Officer, Owner, or Designee <br />W4-r- <br />Date