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~~ ~~ <br />ANNUAL F~E and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~/LBCR,LLC <br />J M-1992-054 <br />Ignacio Pit <br />July 14, 2007 <br />$$688.00 (Due on or before your anniversary date) <br />La Plata <br />`~L1IVISIOn of Keparr~8t On <br />M'n~n9 and Safety <br />d JUG 0 2200 <br /> <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_suhmit_the_anmral~ee,_a_report Ana mar showing .the_extent_n~current_dishuhances_.to. affected_laud,__ _ <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 yeaz, 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 />man. If no new disturbances or reclamation have occurred during the previous year and no new chances to <br />the previous year's moo are necessary, then no new moo is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately dabeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Todd Fisher <br />Permittee Name: LBCR, LLC <br />Address: 1440 Blue Sage Ct. <br />Boulder, CO 80305 <br />Phone Number: (303) 499-0707 <br />Fax Number: <br />If you have additional comments and/or information that should be <br />below or a ch it to this form along with your written report and map. <br />~~~ h~sMcr ~ {M~..,,,~,- <br />Si e of Corpo Officer, Owner, or Designee <br /> <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />Date <br />