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<br />PERMITTEE NAME <br />PERMIT NO.: <br />OPERATION NAME: <br /> <br />J <br />ANNUAL FEE and REPORT REQUEST <br />Midwestern Farms Resource dba Eastern Colorado Aggregates <br />X993-059 PtEcE w ED <br />Midwestern Farms <br />ANNIVERSARY DATE: March 4, 2009 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Prowers <br />AAR 0 L 2009 <br />Division of Reclamation, <br />Mining and Safety <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 annual fee, a report and map showing the extent of current disturbances to affected 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 per-formed 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 may 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 changes to <br />the previous year's may 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: Joe C. Baxter <br />Permittee Name: Midwestern Farms Resource dba Eastern Colorado Aggregates <br />Address: 2101 Main Street <br />Rye, CO 81069 <br />Phone Number: <br />Fax Number: <br />(719) 489-3385 <br />(719) 489-6915 <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 with your written report and map. Annual Report instructions are enclosed. <br />I nYYJ A AAA i &-A <br />Signature of Corp r e (5fficer, Owner, or Designee <br />Z)--) G6 O q <br />Date