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?'v ? ??T <br />ANNUAL FEE and REPORT REQUEST <br />Cross Mountain Ranch Ltd. Partnership ROW-WED <br />PERMITTEE NAME: <br />17 <br />PERMIT NO.: J M-1979-102 V"'M 16, N"19 <br />OPERATION NAME: Kagie Gravel Pit Division of Reclamation, <br />MEn'ngv & Safoty <br />ANNIVERSARY DATE: June 21, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: Routt <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 />- reclama ion accomp fished to ate and during the preceding year, new disturia ices tfiat are -antic ipabe-d-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 year's may 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 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: Bernard J. Petersen <br />Permittee Name: Cross Mountain Ranch Ltd. Partnership <br />Address: P.O. Box 897 <br />Craig, CO 81626-0897 <br />Phone Number: (970) 824-2803 <br />Fax Number: (970) 824-7081 <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 an ap. Annual Report instructions are enclosed. <br />? ross ?oun-?-,? ?anel? <br />IYV <br />Signatur of Corporate Officer, Owner, or Designee <br />2,11 f) <br />Date <br />/Vb