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PERMITTEE NAME: Konig Ag Co. °° <br />PERMIT NO.: ,M- 2010 -055 D EC 1 5 2011 <br />OPERATION NAME: Konig Borrow Pit <br />ANNIVERSARY DATE: December 28, 2011 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <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 />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: Joel Konig <br />Permittee Name: Konig Ag Co. <br />Address: 37231 Hwy. 14 <br />Phone Number: <br />Fax Number: <br />Date <br />Briggsdale, CO 80611 <br />(970) 656 -3657 <br />Signat> of Corporate Offic , Owner, or Designee <br />r <br />4 C)r <br />ANN AL FEE and REPORT REQUEST <br />Divisior; <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 />