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Aj-- 4- &r <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST _ <br />? rn <br />American Gypsum Company LLCM/ <br />M-1984-041 <br />Eagle-Gypsum Mine <br />December 24, 2009 <br />$791.00 (Due on or before your anniversary date) <br />Eagle <br />IECIMv <br />c/0EC 0 8 2009 <br />Division orsd Safety R, <br />Mining <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 />reciarnation accomplished -to-date-and-during-the preceding year, new di-sturbances thafare 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 may 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: Stephen A. Onorofskie <br />Permittee Name: American Gypsum Company LLC <br />Address: 740 Hwy 6 <br />Gypsum, CO 87637 <br />Phone Number: (970) 524-9700 <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 />- Z'e <br />Signature of Corporate Officer, Owner, or Designee <br />Date