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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />(?v * R R <br />ANNUAL FEE and REPORT REOUEST <br />Mountain Region Corporation <br />,IVI-1995-005 <br />Orchard Mesa Aggr <br />February 16, 2011 <br />RECEIVED <br />L/ APR 0 5 2011 <br />Division of Reclamation, <br />1P Mining & SafafY <br />$791.00 (Due on or before your anniversary date) <br />Mesa <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-mccomplishe-d-to- date-and-during-the-preze mg year,- rTew disturbances fiat are anti`cipa e o 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 may to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />man. If no new disturbances or reclamation have occurred during 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: Sandra R. DuCray <br />Permittee Name: Mountain Region Corporation <br />Address: 117 29 3/4 Road <br />Grand Junction, CO 81503 <br />Phone Number: (303) 242-5461 <br />Fax Number: (970) 242-6728 <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 maps Annual ?Report instructions are enclosed. <br />07 4AALW <br />ZOO <br />Signature of Corporate Off r, Owner, or Designee <br />l <br />flae.tarr` J Y, <br />Date