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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 anticipated <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 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: Steve Baker <br />Permittee Name: 3B Enterprises, LLC <br />Address: P.O. Box 1665 <br />Craig, CO 81626 <br />Phone Number: (970) 824 -0225 <br />Fax Number: (970) 824 -6250 <br />J.46,./ <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />kr '- R PT' <br />ij 3B AANN FEE and REPORT REQUEST <br />Enterprises, LLC <br />M- 2001 -060 <br />Deakins Pit <br />August 29, 2011 <br />$791.00 (Due on or before your anniversary date) <br />Moffat <br />RECEIVED <br />AUG 2n 2011 <br />.0 Division c„ r..-:c <br />Mining and 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 />