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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 the annual fee, a report and map showing the extent 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 your 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 year'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: <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Date <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Mike W. Ludlow <br />Peabody Sage Creek Mining LLC <br />36600 Routt County Road #27 <br />Hayden, CO 81639 <br />(970) 276-7001 <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 />enclose <br />ature . Corporate Officer, Owner, or Designee <br />''I / - c'1I <br />MAPERMITIMASTERDOCUMENTS\M -AF -04 <br />te* an <br />ANNUAL FEE and REPORT REQUEST <br />Peabody Sage Creek Mining LLC <br />/ M- 1978 -315 <br />Red Rock Pit <br />November 22, 2011 <br />$323.00 (Due on or before your anniversary date) <br />Routt <br />RECEIVED <br />1/ NOV 4$ C�ii <br />()Melon of Reclamation, <br />Mining and Safety <br />&9 Catvm a, vl <br />97c) z1 - 7ov3 <br />