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o? <br />Ern ?4 <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: ?Rockbottom, LLC Rer'fz/M-1989-084 "'JAN <br />PERMIT NO.: JAN <br />OPERATION NAME: Oak Creek Gravel Pit 2200 <br />Division of Reclamation <br />ANNIVERSARY DATE: January 20, 2009 "ning and safety <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 <br />operator shall-submit the annual fee, a-repot-t-and-map-showving the extent-of.current d sturbances_ta_affected._- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report Please note that an adequately labeled map that clearly <br />delineates and includes the 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 M. Russell <br />Permittee Name: Rockbottom, LLC <br />Address: 9042 S. 106 Rd. <br />Alamosa, CO 81101 <br />Phone Number: (719) 587-3630 <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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br /> <br />Date <br />M TERMITWASTERDOCUMENTSN-AF-04