2011-06-01_REPORT - M2004022

• Permit No: M2004022
• IBM Index Class Name: Report
• Doc Date: 6/1/2011
• Doc Name: Annual Fee/Report/Map
• From: Hilltop Aquatic
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

ANN'CrtlL FF.eand REPORT RE VEST
PF.RNlTTTEE NAME: 'lltop Aquatic Investments, LLCaka Raindance Aquatic Invest
PERMIT' NO.: M-2004022
OPERATION NAME: Raindance Sand and Caravel Mine RECEIV
ANNIVERSARY DATE; March 4, 2011 /.. Y;d 2011
ANNUAL FEE Dl.lF: $$791.00 (Due on or before your anniversary date) -nivision of Reclamation,
COUNTY: Weld "' Mining and Safety
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
shall submi.l, the annual fee, a report and rrnap showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming ,year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous vear and no new changes to
the previous year's map are necessary, then no new map is required, provided that the Operator shall state
this in the Annual Report. Please note that (inadequately labeled male that clearly delineates and includes the
above elements may s ice jim a written report.
Division records indicate the following pcrmittee contact information. Please verify and make any necessary
changes:
Perm ittce Contact: Martin Lind
Perminee Name:
Address:
Phone Number:
Hilltop Aquatic Investments, LLCaka Rainda Aquatic Trlvest
A r G
1625 Pelican Lakes Pt., Ste. 20)
Windsor, CO 80550
[phone]
l
Fax Number: [phone] _
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report, and map. Annual Report instructions are enclosed.
Signal of Corporate Officer. (hurter, or Designee
-Z6 -I/-
Date
£/£ d << 90 68Z£8£0£ SWSa 05 60 5Z - 50 - L LOZ