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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A UAL FEE and REPORT RE UEST <br />on Kehn Construction, Inc. <br />M-1989-056 <br />Timnath Pit <br />February 24, 2009 <br />$$791.00 (Due on or before your anniversary date) <br />Larimer <br />o/< <br />/FEB 2 0 7669 <br />Division of Psc,amation, <br />Mining and Safety <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, Ake- 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 />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's may 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: Don Kehn <br />Permittee Name: Don Kehn Construction, Inc. <br />Address: 6550 S. CR 5 <br />Phone Number <br />Fax Number: <br />Fort Collins, CO 80528 <br />(970) 226-4111 <br />(970) 226-4115 <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 /> <br />Signature of Corporate Officer, Owner, or Designee <br />?-- c_l - 0 °1 <br />Date