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kEC[PVVUW <br />(A?Tg:NUAL FEE nd REPORT REQUEST <br />MAY t 2010 <br />?O <br />PERMITTEE NAME: !l(pine Rock (Company Division of Reclamation, <br />PERMIT NO.: ?M-1982-086 Mining & Safety <br />OPERATION NAME: Fairplay Site <br />ANNIVERSARY DATE: June 11, 2010 D? <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) t COUNTY: Park <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 />tlhe__date: active_operations ceased for the_year, if any_ <br />of active-operations, and <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 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: Bob Stewart <br />Permittee Name: Alpine Rock Company <br />Address: 14802 W 44th Ave <br />Golden, CO 80403 <br />Phone Number: (303) 279-6611 <br />Fax Number: (303) 279-6216 <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 />Signature of Corporate Officer, Owner, or Designee <br />611 1-110 <br />Date