2010-09-16_REPORT - M1977301

• Permit No: M1977301
• IBM Index Class Name: REPORT
• Doc Date: 9/16/2010
• Doc Name: Annual Fee/Report/Map
• From: Colorado Lien Company
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: MAC
• Media Type: D
• Archive: No

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PERMITTEE NAME:
PERMIT NO.:
ANAL FEE and REPORT REQUEST
Colorado Lien Company
v'M-1977-301
REC1L
/ SEP 16 2a to
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OPERATION NAME: Roberts Quarry -?VC9ivision of Peclamation,
ANNIVERSARY DATE: September 22, 2010 Mininj & 5aictX
ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date)
COUNTY: Larimer
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
_--reclamation accomplished to date and, during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous year's map are necessary, then no new map is required, provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact:
Permittee Name
Address:
Phone Number:
Fax Number:

Colorado Lien Company
P.O. Box 440
Rapid City, SD 57709
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of Corporate Officer, Owner, or Designee
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Date