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7 7. . v,., <?4 <br />,w ?- WT <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />v1 AUG 0 2 2010 <br />Div4W of Ree4a Men, <br />Alining and Safety <br />#10 Enterprises - High Lonesome <br />Account # Amount <br />101 00 t to 3,23 . oa <br />#17 Enterprises, LLC <br />M-1978-221 <br />K-Bar-T Pit <br />August 23, 2010 <br />$323.00 (Due on or before your anniversary date) <br />Rio Blanco <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-11.6, each year, on the anniversary date of the permit, an operator <br />sball--submit--the aim al--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 begin ning <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 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 sz ffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Dong-Bemi _ <br />Permittee Name: #17 Enterprises, LLC <br />Address: P.O. Box 88 <br />0275 CR 22 <br />DeBeque, CO 81630 <br />Phone Number: -")-2t3=51 32 <br />Fax Number: <br />If you have additional comments and/or information that <br />below or attach it to this form along with your written report <br />or Designee <br />Date <br />lq?o? a?3 -q?k? <br />C ?AG) 2`u3 - s2z-t <br />lA0"nTiW ???!'ti??l?-S--dam <br />KG vlG w•a 4-i OAS /'-?G <br />h,e- Pe.GNtouS y-'A ,-ahd h0 huA? <br />64V4_4j,e,s y <br />01? k lug spry . <br />ie provided to the Division, please provide it <br />d map. Annual Report instructions are enclosed.