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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lindsey Canyon, LLC <br />M-2000-072 <br />Lindsey Canyon LLC <br />October 29, 2010 <br />$323.00 (Due on or before your anniversary date) <br />Montrose <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 />_. <br />_L .1 to J_- _ __.1 _1__.----- ._, al__ .]_._? year, new J._`_.L ___ _ ?7__? ___?_.__?_.1 to __UI? <br />-.. ,.1_?_a. ..? accompli <br />reclalllauun llsllcu Lu U2LLG allU uUllll?' Luc lJlcl.cuul?' ycal, 11GW uLJLUlUtllll?eJ ulaL alG a11L1l:lYaLGU Lu VI:Lj <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 man 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: Gary W. Cooper <br />Permittee Name: Lindsey Canyon, LLC <br />Address: 11554 64.50 Road <br />Montrose, CO 81401 <br />Phone Number: (970) 249-8348 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date