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~1~ <br />PF.RMITTGE NAME: <br />PER Mfr NO.: <br />OFERATION NAME; <br />ANNIVERSARY DATE: <br />ANNUAL FEB DUE: <br />COUNTY: <br />rmw <br />ANNUAL FEE and REPORT REQUEST <br />SSW Chambers, LLC i ' <br />L1~7-2003-016 <br />Heit Sand and Gravel Mine <br />September 27, 2006 <br />1'J~Ep 222006 <br />OIVIsIp7 nt <br />Mlnin~ ndotamation, <br />sarery <br />$688.00 (Due on or bet'ore your anniversary date) <br />Weld <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />-'-' snail- subiiiit'tiie annual fee;'a-repori and-map-showing tSte extetti vf"curra~tt disturbances t~-affected-ia~Su; •----' <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 lieport <br />& Fee requirement is not me# nnti4we havg;received the following components: fee, renort, and associated <br />ntap (All are requirediregardless of'th'g:.lev,~l of disturbance or absence of disturbance during the previous <br />year). Please note that ari ddeguately Ibbeled may tlwt clearly delineates and Includes the afiove elentenls may <br />suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: ' <br />Pennittee Contact: Mark D. Campbell <br />Permittee Name: SW Chambers, LLC <br />Address: 333 W. Fiatnpden Ave., Ste 810 <br />Englewood, CO 80110 <br />Phone Number: (303) 534-1040 <br />Fax Number: <br />[f you have additional comments andlor 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 Keport instructions are enclosed. <br />~~~ r <br />Signature of Corpor fficer, Owner, or Designee <br />_ 9//8/06 <br />Date <br />