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0l?- <br />2 <br />,gyp RECEIV ! <br />AL FEE aid REPORT REQUEST ? <br />FE9 2 2 2011 <br />Division of Reclamation, <br />PERMITTEE NAME: ?-Clear Creek District Water Providers, L.L.C. to Mining and Safety <br />PERMIT NO.: A-2004-067 <br />OPERATION NAME: MMRR Quarry <br />ANNIVERSARY DATE: February 22, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Gilpin <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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous vear's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Robert A. Lembke <br />Permittee Name: Clear Creek District <br />Water Providers, L.L.C. <br />Address: 8301 E. Prentice Ave., Ste. 100 <br />Greenwood Village, CO 80111 <br />Phone Number: (303) 773-1005 <br />Fax Number: (303) 773-1176 <br />If you <br />or attach <br />comments and/or information that should be provided to the Division, please provide it <br />this forte along with your written report and map. Annual Report instructions are <br />Signature of Corporate Officer, Owner, or Designe <br />a/15-/(t <br />Date <br /> <br />M: \PERMITIMAS TERDOCUMENTS\M-AF-04