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-. , <br />Ir, <br />4 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />RECEIVED <br />AUG 10 7009 <br />Division of Reclamation, <br />C! __ Mining and Safety <br />August 4, 2009 <br />$$791.00 (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 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,-reelamation-that will=be-performed--during-the-eoming-yearthe-dates for-t4he-beginning- _- <br />-- of active operations; dnd"the date active operatibn-s 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 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: Jon File <br />Permittee Name: Farfrumwurkin, LLLP <br />Address: P.O. Box 983 <br />1163 Oakhurst Dr. <br />Broomfield, CO 80038 _ <br />Phone Number: (303) 404-3225 <br />Fax Number: (303) 404-0778 <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 />- q"p I -? <br />Signature Corporate Officer, Owner, or Designee <br />Date <br /> <br />1M4- C, <br />A UAL FEE and 4 / PORT REQUEST <br />?Farfrumwurkin, LLLP <br />//M-2004-047 <br />File Pit 112