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q` r <br />AN L FEE' and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Ste 1 Rose I. Inc. <br />M-22006-031 <br />Steel Rose 1 <br />May 10, 2011 <br />'r- <br />?ri' I . I G ?' ?'01 1 <br />DiVlSlon v+ -WC4araas[ion, <br />Mining and SWOty <br />$$259.00 (Due on or before your anniversary date) <br />Park <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 th`e annual-fee, a report 'rifiowingtenf 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 vour revised written annual report and annual report map 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: Scott B. West <br />Permittee Name: Steel Rose I. Inc. <br />Address: 802 3rd St. <br />Colorado Springs, CO 80907 <br />Phone Number: (719) ? 5 V 4(626 <br />o 41037 <br />Fax Number: (719 iro 3 2 - q& Z (o <br />-A-ex-e- Le. x,-s+ Wli <br />0-10 Atlis i b g <br />r?- &M 6A, - <br />b h -h a r?\) i s kS <br />C?i l <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 <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:IPERMITIMASTERDOCUMENTS/M-AF-02. DOC