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I- . L . <br />ANNUAL FEE nd REPORT REQUEST <br />PERMITTEE NAME: k6arma Bayshore LLC <br />PERMIT NO.: A-1982-015 <br />OPERATION NAME: St. Vrain Lakes, Filing 1, Slurry Wall <br />ANNIVERSARY DATE: December 10, 2008 <br /> <br />PIDEC 1.6 200 <br />Qroision of 8 <br />Minin Reclamation <br />9 and Safety , <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <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-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 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 />mM. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the Drevious vear's map are necessarv, then no new map is required, provided that the Onerator 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 sifce for a written report <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Tyler Packard <br />Permittee Name: Carma Bayshore LLC <br />Address: 188 Inverness Dr. West, Ste. 150 <br />Englewood, CO 80112 <br />Phone Number: <br />Fax Number: <br />(303) 706-9451 <br />(303) 706-9453 <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 />/2-&1 to I, <br />Date