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i ^, E a ?QRT ANN L FE REQUEST <br />Aquatic Investments, LLC <br />PERMITTEE NAME: Hilltop2004-022 <br />{ Y <br />PERMIT NO.: <br />OPERATION NAME: Raindance Sand and Gravel Mine <br />ANNIVERSARY DATE: March 4, 2009 <br />ANNUAL FEE DUE: $$791.00 (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 accolished to_ date and during the preceding_year, new disturbancesthat 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 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: Martin Lind <br />Permittee Name: Hilltop Aquatic Investments, LLC <br />Address: 1625 Pelican Lakes Pt., Ste. 201 <br />Windsor, CO 80550 <br />Phone Number: (970) 686-5828 <br />Fax Number: <br />No ie,lF ? 'D if 7 /z' EAtCC - S <br />??2frLs??n ?-Ti?sy N <br />?O?Elrio?f /,C?R? <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 ure of Corporate Officer, Owner, or Designee <br />Date