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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL I EE an?PORT REQUEST <br />PHall Irwin Corporation <br />V4-2006-003 <br />Parker-Dersham Resource <br />April 9, 2009 <br />v k- <br />ec- S <br />A 2' <br />1I?ilfi- ' 0: ? t"t.,. <br />Wdining a ,-.d safra;y <br />$$791.00 (Due on or before your anniversary date) <br />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, 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 Drevious vear's map are necessary, then no new map is reauired, 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: Jim McFarland <br />Permittee Name: Hall Irwin Corporation <br />Address: 301 Centennial Drive <br />Milleken, CO 80543 <br />Phone Number: (W-0)45z G6 <br />Fax Number: (97-4 127= <br />4'i0 -?Fl- 72?"7 <br />4770 - 5)7-7 - -7 2 8 °7 <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 kith your written report and map. Annual Report instructions are enclosed. <br />of <br />, Owner, or Designee <br />D to