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D? <br />f <br />ANNUAL FEE And RE ORT REQUEST <br />PERMITTEE NAME: T hornburg Family Limited Partnership /SEP 20UC? <br />PERMIT NO.: ?4-1983-060 DiV4,en of Reclam;gion, <br />1v Mining and Safety <br />OPERATION NAME: Thornburg Pit 77/ <br />ANNIVERSARY DATE: September 27, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Adams <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 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: Stanley Thornburg <br />Permittee Name: Thornburg Family Limited Partnership <br />Address: 50747 E. 38 Avenue <br />Bennett, CO 80102 <br />Phone Number: (303) 644-3424 <br />Fax Number: <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 />Signatur of Corporate Officer, Owne , or Designee <br />q /oz/ /0 47 <br />ate