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4- R Ir <br /> ANNUAL FEE and REPORT REOUEST <br /> 7 <br />PERMITTEE NAME: Benson Brothers <br />4 <br /> / <br />PERMIT NO.: M-2005-071 <br />OPERATION NAME: Benson Brothers Red Shale Pit <br />ANNIVERSARY DATE: November 13, 2009 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Delta <br /> <br />NOV 0 9 2009 <br />Division of Reclamation, <br />Mining and Safety <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 />-- -- recla.'nation-.nation-to-date-and during-the preceding -year-,-new-disturbanees-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 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: Ed Benson <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax Number: <br />Benson Brothers <br />21240 Austin Rd <br />Austin, CO 81410 <br />(970) 835-3128 <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 />SlIgnature of Corporate Offic r, Owner, or Designee <br />/0 - 3 24:2e'? <br />Date