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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />t' P -'?- RPW- <br />ANNUAL FEE and REPORT RE UEST <br />Rio Grande Ranch, LLC <br />M-2004-045 t <br />Hanna Pit No. 1 <br />March 28, 2009 <br />IVED <br />H,ArR, 2), 2999 <br />Division of Reclamation, <br />Mining and Safety <br />$323.00 (Due on or before your anniversary date) <br />Rio Grande <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-am-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 />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 may 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: Kevin W. Ames <br />Permittee Name: Rio Grande Ranch, LLC <br />Address: P.O. Box 880 <br />Phone Number: <br />Fax Number: <br />If you have ad <br />below or att h <br />Sign re of <br />Date <br />South Fork, CO 81154 <br />(719) 657-0261 <br />(710 657-0372 <br />I comments and/or information that should be provided to the Division, please provide it <br />is form along with your written report and map. Annual Report instructions are enclosed. <br />, Owner, or Designee <br />o /"Xa'V