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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: William & Beverly Caldwell and Albert & Lola Nesselhuf JUN L 6 2009 <br />PERMIT NO.: M-1997-071 Divis" of Reciarn#Aw, <br />Mi*Mg and Safety <br />OPERATION NAME: Caldwell-Nesselhuf Pit No. 1 <br />ANNIVERSARY DATE: June 30, 2009 <br />ANNUAL FEE DUE: $5791.00 (Due on or before your anniversary date) <br />COUNTY: Crowley <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 />reclama if'on accomp-Iisiied-to-date-acrd during-tire-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 changes to <br />the previous Year's map are necessarv. 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: Albert F. Nesselhuf, Jr. <br />Permittee Name: William & Beverly Caldwell and Albert & Lola Nesselhuf <br />Address: 31738 Rd 13 14" <br />Manzanola, CO GF PR.7ip-sede- <br />Phone Number: (719) 462-5236 <br />Fax Number: (917) 254-3231 <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 O fi Ow r, or Designee <br />? /. -V 1 /a <br />Date