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.P lP * RP T <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Eldon & Cornelia Reynolds V PF-C ® <br />PERMIT NO.: M-2006-028 SEP 29 2009 <br />OPERATION NAME: Reynolds Pit Division of R'2clamation, <br />and Safety <br />ANNIVERSARY DATE: October 30, 2009 Mining <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Delta <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-precedmg-year, -new-disturbances that-are-anticipated- to-occur-- <br />duringthe 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: Eldon Reynolds <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Eldon & Cornelia Reynolds <br />691 Veinte Drive <br />Delta, CO 81416 <br />(970) 874-9554 <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 1cer, Owner, or Designee <br />q <br />Date