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Ar 1 -1 0 -1ANNUAL FEE and REPO tT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL. FEE DUE: <br />COUNTY: <br />A eel Rose I. Inc. <br />:7m-2006-031 <br />Steel Rose 1 <br />L0 <br /> <br /> <br />May 10, 2009 <br />S$259.00 (flue on or before your anniversary date) <br />Park <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during; the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vo r revised written annual report and uunaiaul re ort roa to-this-form: -The Annual-- - - - <br />Report & Fee requirement is not met until we have received the following components: fee., re ort. And <br />associate man. If no new disturbances or reclamation have occurred during the grevioui year and no <br />new chap es to the previous ear's maR are ecessarv theta no new ma is re ulred rovided that the <br />Operator shall state this in the Annual Report. Please nare that an adequately labeled map that clearly <br />delineates and includes the above elements may sutf ce for a written report. <br />Division records indicate the following; permittee contact information. Please verify and make any necessary <br />changes: <br />Pennittee Contact: <br />SG?t? .?, t!J?.sy' <br />Pertnittee Name: Steel Rose I. Inc. <br />Address: <br />Colorado Springs, CO 80906 pew y S,?nW • Cd' gQ? `7 <br />Phone Number: ( 7I 9 (a `3 r y? 07 -- <br />Fax Number: - - -- - 7 I ) (o 33 ` y90 7 - <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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:\LsERM1TMASTLRDOCUMENTW.AMIDOC _