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cJl? <br />ANNUAL FiE and REPORT REQUEST •! <br />PERM E NAME: AFive Rivers Ranch Cattle Feeding LLC PERMIT NO.: 4-1977-223 741 1 <br />OPERATION NAME: Wiley Pit <br />ANNIVERSARY DATE: February 7, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <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 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 durine the previous year and no new changes to <br />the previous year's may are necessary, then no new may 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: Doug Morris <br />Permittee Name: Five Rivers Ranch Cattle Feeding LLC <br />Address: 2258 US HWY 50 <br />Phone Number: <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />bel w or atta it to this form along with your written report and map. Annual Report instructions are enclosed. <br />4L <br />Si ature o Co rate Officer, Owner, or esignee <br />JA-ej U,T 3 <br />Date <br />Lamar, CO 80538 <br />(719) 829-4841