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ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Sutherland Brothers, Inc. RWMED <br />PERMIT NO.: M-1996-031 JUL 0 6 2009 <br />OPERATION NAME: Weimer No. 2 / D'V** Qt ftQlamation, <br />ANNIVERSARY DATE: July 2, 2009 M*Q and Safety <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <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 />reclamat-ion-aeeemplished-to-date-and-dur-ing--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 previous year's map are necessarv. 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 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: Bob Sutherland <br />Permittee Name: Sutherland Brothers, Inc. <br />Address: P.O. Box 889 <br />Nucla, CO 81424 <br />Phone Number: (970) 864-7662 <br />Fax Number: (970) 864-7980 <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 />y-?-a <br />Date