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999 <br /> ANNUAL FEE and REPORT REOUEST r c <br /> PERMITTEE NAME: Rock Island Land Co.,LLC <br /> PERMIT NO.: M-1998-052 JU� 192001 <br /> OPERATION <br /> NAME: J Rock <br /> Island <br /> lOperation OiVtSinnOf Minerals and Geology <br /> ANNIVER <br /> ARY <br /> ANNUAL FEE DUE: $281.00(Due on or before your anniversary date) <br /> COUNTY: Summit <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 <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. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> repay. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Sam McCleneghan <br /> Permittee Name: Rock Island Land Co., LLC <br /> Address: P.O. Box 1012 <br /> p �f t;pvrtC�T <br /> Breckenridge,CO 80424 <br /> Phone Number: (970)453-6360 <br /> Fax Number: (970) 453-6395 <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 /> enclosed. <br /> _ Sa .. GCr eyT9� <br /> Signature e Corporate Officer or Owner <br /> Date <br /> M?PERM nQ.tASTER DOC UM ENTS W-A F-01 <br />