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I'llo <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Aj r <br />ANAL FEE and REPORT REQUEST <br />PC lorado Rose Red Corporation <br />1978-332 <br />Colorado Rose Red Pit <br />October 23, 2009 <br />f??FCp-ivr.® <br />v/OCT 13 2009 <br />C)ivision ct KW-clam.jaion, <br />k1'ening end Safety <br />$$323.00 (Due on or before your anniversary date) <br />Larimer <br />According to C.R.S. 34 P2.5-116 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 ye, 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 rev6ed written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is ?ot 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 Retort. 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: Daniel J. Liesveld <br />Permittee Name: Colorado Rose Red Corporation /11Q C1t!9z ti&5 1 tS <br />Address: 148 Cheyenne Ct <br />Lyons, CO 80540 <br />F <br />Phone Number: (363) 823-6023 <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 />f <br />, e?? l . <br />Signatur of Corporate }Officer, Owner, or Designee <br />/// 169-d <br />Date