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ANNUAL FEE anIREPORT RE VEST <br />PERMITTEE NAME: ? inneo Feedlot, LLC <br />PERMIT NO.: -1980-135 OCT O 7 2010 <br />OPERATION NAME: Headley 40 Division of Recla:?,jatlon, <br />ANNIVERSARY DATE: October 7, 2010 Mining a Sa4 etY <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Morgan <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 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 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: Joel Chisum <br />Permittee Name <br />Address: <br />Phone Number: <br />Pinneo Feedlot, LLC <br />32295 Hwy 34 <br />P.O. Box 384 <br />Brush, CO 80723 <br />Fax Number: <br />(970) 842-0701 <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 />is A: - /D <br />Date