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.. <br />nJ <br />1 k' <br />CAF t R r <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Raymond C. Petersen VW RECEW <br />PERMIT NO.: M-1981-236 c? <br />OPERATION NAME: Colorado River Ranch Gravel Pit FEB 18 Zooq <br />Division of Keclamation, <br />ANNIVERSARY DATE: March 29, 2009 Mining and Safety <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Grand <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 vour revised written annual report and annual report map to this form. The Annual Report <br />& F'ee 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 vear's map are necessary, then no new map is renuired. 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: Raymond C. Petersen <br />Permittee Name: Raymond C. Petersen <br />Address: P.O. Box 832 <br />Kremmling, CO 80459 <br />Phone Number: (970) 724-9327 <br />Fax Number: (970) 724-9327 <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 />Si ture of Corporate ficer, Owner, or Designee <br />February 17, 2009 <br />Date