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kip *- R P? <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Calx Minerals, LLC <br />PERMIT NO.: M-1982-121 <br />OPERATION NAME: Mid-Continent LST <br />ANNIVERSARY DATE: April 25, 2011 <br />ANNUAL FEE DUE: $791.00 (Due on or before your anniversary date) <br />COUNTY: Garfield <br />ftFCEIVE® <br />APR z0" <br />f39'V*i0V1 i rig ` ' <br />Miring act 0 <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 vour 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 />man. 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 man 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: Ben Miller <br />Permittee Name: Calx Minerals, LLC <br />Address: 2080 W Hamilton Place <br />Sheridan, CO 80110 <br />Phone Number: (303) 761-4770 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attac ' to this fo along with your written report and map. Annual Report instructions are enclosed. <br />&r, M, I JLr <br />Signature of Corporate Officer, Owner, or Designee <br />yZ! // <br />Date