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A� e? r <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: MaskRanch, LLC <br />PERMIT NO.: M- 2002 -087 <br />OPERATION NAME: Mask Ranch Gravel Pit <br />ANNIVERSARY DATE: November 25, 2009 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Archuleta <br />C111VED <br />JAN 0 4 2010 <br />t�Division of Reclamation, <br />v 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 />- - - -- -- - reclamation accmnplishe date - and -°during the-precedingyear, 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 />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 vear's map are necessarv. then no new map is required, provided that the O perator 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: Dennis Walker <br />Permittee Name: MaskRanch, LLC <br />Address: 1281 NW Business Hwy 36 <br />Hamilton, MO 64644 <br />Phone Number: (816) 583 -7934 <br />Fax Number: (816) 583 -2770 <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 />xa� <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />