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@G S <br /> <br /> <br /> A AL FEE and REPORT REQUEST RECEIVED <br />PERMITTEE NAME: it", Carper 1 AR G '12010 <br />PERMIT NO.: -200 <br /> Division of Reclamation, <br />OPERATION NAME: Carper Pit #2 4-6 Mining & Safety <br />ANNIVERSARY DATE: March 2, 2010 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Phillips <br />©I` <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 />_recfamation acc6rfi Tished_.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 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 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: Tim Carper <br />Permittee Name: <br />Address <br />Phone Number: <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 />f?/ <br />Tim Carper <br />42538 Co. Rd. 09 <br />Haxtun, CO 80731 <br />(970) 774-7126 <br />of Corporate gfficer, Owner, or Designee