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ANNUAL F'EE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Hall-Irwin Corporation <br />/riI-2002-120 <br />Bernhardt Resource <br />April 15, 2007 <br />~~~ <br />-~®~ ~ <br />%~P ~~ <br />~ivi8ton o. ~ B?pOj <br />/ Min~n9 aad Sa e ~ on, <br />$$688.00 (Due on or before your anniversary date) <br />Weld <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each yeaz, on the anniversazy 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 yeaz, 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 />ofactive operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual resort and annual report maa 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 durinti the previous year and no new chanties 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: Jeff Gregg <br />Permittee Name: Hall-Irwin Corporation <br />Address: 301 Centennial Dr. <br />Milliken, CO 80543 <br />Phone Number: (970) 587-7270 <br />Fax Number: (970) 587-7289 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below attach it o this form along with your written report and map. Annual Report instructions are enclosed. <br />afore f Corporate fficer, Owner, or Designee <br />~~IS ~Q <br />Date <br />