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4- 2 <br />ANNUAL FEE and REPORT RE VEST <br />PERMITTEE NAME: 7mountain Region Corporation <br />FEB 18 2010 <br />PERMIT NO.: / M-1995-005 Divide of Reclamation, <br />OPERATION NAME: Orchard Mesa Aggr A+lini?tg and Safety <br />ANNIVERSARY DATE: February 16, 2010 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Mesa <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of th permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbanc s to affected land, <br />reclamation accomplished to dateand during the preceding year, new- disturbances-that are--I ticipated 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 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 suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and snake any necessary <br />changes: <br />Permittee Contact: Sandra R. DuCray <br />Permittee Name: Mountain Region Corporation <br />Address: 117 29 3/4 Road <br />Grand Junction, CO 81503 <br />Phone Number: (303) 242-5461 <br />Fax Number: (970) 242-6728 <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 />h0 .,.s.c.r o-, ?? <br />Signature of Corporate Offs r, Owner, or Designee ??i° p"a-? •.P -a# <br />Date rt.? t """?