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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />- *- -PT- <br />ANNUAL FEE and REPORT RIEOUEST <br />Bumgarner Ranches, Inc. <br />M-1980-027 <br />Bumgarner Ranches Gravel Pit <br />February 2, 2010 <br />UtEcPaIVE <br />FEB 0 3 2010 <br />Divimsion of Keclamation, <br />Mining and Safety <br />L7 $791.00 (Due on or before your anniversary date) <br />Grand <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 />Please attach vour revised written annual report and annual report may 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 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 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: Gary Bumgarner <br />Permittee Name: B6Kgamer Benches, Inc. <br />Address: P.O. Box 186 <br /> Kremmling, CO 80459 <br />Phone Number: (970) 724-9325 <br />Fax Number: (970) 724-9632 <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 />A. A_ <br />S' ture of orate Officer, Owner, or Designee <br />01 <br />Date -?