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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE VEST <br />It - McAtee Construction Co. <br />/M-1986-147 <br />Harley Pit #1 <br />cRiVED <br />ADEC 0 7 200 <br />Division ota d Safety n, <br />4. Mining <br />December 2, 2009 <br />$$791.00 (Due on or before your anniversary date) <br />Logan <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 />Pleas attach your revised written annual report and annual re port 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 dis turbances or reclamation have occurred during the previo year and no new changes to <br />the previo year's map are necessary, then no new map is required, pro vided that t he 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: Darren Gebhart <br />Perm ittee Name: McAtee Construction Co. <br />Address: P.O. Box 1908 <br />Sterling, CO 80751 <br />Phone Number: (970) 521 -0651 <br />Fax Number: (970) 522 -9725 <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 Officer, Owner, or Designee <br />l 2-- Z U� <br />Date <br />