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PERMTTTEE NAME: <br />PERMTT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~=~P1 <br />ANNUAL FEE and REPORT REQUEST <br />Sutherland Brothers, Inc. <br />dGI-1996-031 <br />Weimer No. 2 <br />July 2, 2007 <br />, ~.,R <br />`~ ~ ~ • M ~)+r~~ <br />y/r JUN ? 5 2007 <br />Mb~ptg t~ on, <br />$$281.00 (Due on or before your anniversary date) <br />Montrose <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 annul fee,_a_~poxt_and_map showing_the_extent_occurrent_disturbances_to_affeeted-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 chances 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 Reuort. 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: Bob Sutherland <br />Permittee Name: Sutherland Brothers, Inc. <br />Address: CF.PR.address 1 <br />P.O. Box 889 <br />Nucla, CO 81424 <br />Phone Number: <br />Fax Number: <br />(970)864-7662 <br />(970)864-7980 <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 />Signature of Corporate Officer, Owner, or Designee <br />,?°a~-off <br />Date <br />