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Wa- <br />R CEIVEI3 <br />nd REQUEST <br />ANNW?FEE'a REPORT <br />A PR 2 G L j. i <br />PERMITTEE NAME: .(' verside Aggregates, LLC <br />Division of Reclamation, <br />PERMIT NO.: M-2008-013 jo Mining $ Saf®ty <br />OPERATION NAME: #2 Verhoeff Pit <br />ANNIVERSARY DATE: April 28, 2011 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Bent <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 />--- reGlamation_accomplished?o-&te- and,during. the precedin 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- eginning -' <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 during the previous year and no new changes to <br />the previous vear'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: Rudy Torres <br />Permittee Name: Riverside Aggregates, LLC <br />Address: 1750 County Road HH <br />Lamar, CO 81052 <br />Phone Number: (719) 336-7361 <br />Fax Number: (719) 336-7361 <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 />ignature of Corporate Officer, Owner, or Designee <br />-ZI/5/11 <br />Date