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ty) i4r or- <br />ANNUAL FEE`and REPORT REQUEST <br />PERMITTEE NAME: 'Nikolaus Arnusch <br />PERMIT NO.: 0'M-1981-287 <br />OPERATION NAME: Arnusch Grav Pit 3 <br />ANNIVERSARY DATE: February 25, 2009 <br />RECEIVED <br />kf 17B 0 4 2009 <br />Division of Reclamation, <br />10ining and Safety <br />ANNUAL FEE DUE: $$323.00 (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, rec amation thatwill-Fe performed dbfing-W coming year,-the dates-for-th,e`beginring - <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 />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: Nik Arnusch <br />Permittee Name: Nikolaus Arnusch <br />Address: 34527 WCR 6 <br />Keenesburg, CO 80643 <br />Phone Number: (303) 732-4427 <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 />f ??' d 3 <br />Date