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P? ?- Uq- <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Calx Minerals, LLC <br />PERMIT NO.: M-1982-121 <br />OPERATION NAME: Mid-Continent LST <br />ANNIVERSARY DATE: April 25, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <br /> <br />MAR 3 0 YUU9 ? <br />DMeiOli ow ndum(Y uon, <br />Mh ft and Sd* y <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-accomptishe?d to date acrd-during-tlre preceding year, riew disturbances- that are i n-Ticipated"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 may 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ben Miller <br />C? mozz,' <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Calx Minerals, LLC <br />2040 W Hamilton Place <br />Sheridan, CO 80110 <br />(303) 761-4770 <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 />Signature of Corporate Officer, Owner, or Designee <br />,Z29/??9 <br />Date/