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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE UEST <br />lam`Ranch Land LLC <br />M-2002-096 <br />Ranch Land Rock Pit #1 <br />October 15, 2010 <br />o <br />11 <br />y5?? Re°?a ay <br />4V <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <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-aeeomplishe-d-to-date-and-daring the preceding_y_ear,_ne-w distur anc s 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 Year's man 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: William Peetz <br />Permittee Name: Ranch Land LLC <br />Address: 3925 Hill Circle <br />Colorado Springs, CO 80904 <br />Phone Number: (719) 492-0266 <br />Fax Number: (719) 473-5494 <br />If you have additional comments and/or information that should be <br />below or ch it to this form alon your written report and map. <br />Signature of Corporate Officer, O er, or Designee <br />Dat <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed.