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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <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 />ing t re utrtu1ning ycar,- reclamation. that will -be- performed- during= the- corninb 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 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 year'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: Joe Kraig <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Date <br />S & K No. 1, LLC <br />5000 North Park Dr. <br />P.O. Box 7650 <br />- Colorado Springs, CO 80933 - <br />(719) 599 -8100 <br />F / ,% <br />ANNUAL FEE and REPORT REQUEST <br />�y/`S & K No. 1, LLC <br />, 41 - -1981-121 <br />Hale Pit aka Earl's Pit <br />July 23, 2011 <br />$$323.00 (Due on or before your anniversary date) <br />El Paso <br />RECEIVED <br />.1111 07 2011 <br />yr Division of Reoit rtlittlOn, <br />Mining & Safety <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 />e: ;v-O ,Lt, i.✓7f„ii91' ) A- t/A),,,A_ GR-&rv,✓G / 9"p 4JE-EP Co -trip,/ 7Z k f'ii9cz 77AS <br />53; 9E - r9-R_ o PI) lei 19 FO 4) rRuc,c. '‘) 005 DFMN74e.h1/ 49 R /'io ' Z Ak, /1J�� <br />�� =..ice . • ' OW r6:5 4..)1'2ir Dis?Z//e,6 - , 0 ! <br />Sign of Borate 0 ce , Owner, or Designee <br />