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<br />08/13/2009 14:28 <br />FERMITTEF, NAME; <br />PERMIT NO.: <br />BANKS AND GESSO LLC <br />ANNUA,]G FEE ind'REPORT REOUEST <br />4iones Fine Sand <br />(/M-1992-038 <br />OPERATION NAME: Sand Creek Mine <br />ANNIVERSARY DATE: September I, 2009 <br />A.NNUA.L..1FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY; Adams <br />?J PAGE 03/03 <br />b ? n?L <br />RECEW <br />/AUG 2 ?,r n' <br />.9 <br />DIVIGion <br />A0 <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 Mat will be performed during the coining year, the dates for the beQinvang. <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 poet 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_ nmap are neccessari,. then no new map is re_auired, Droviided that the Operator shall state <br />this_in_ the Annual Report. 'lease note that an adequately labeled map that clearly delineates and includes the <br />above elements may sufface fnr a written report. <br />Division records indicate the following pernnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Daren Palizzi <br />3032748329 <br />Permittee Name: Jones Finc Sand <br />Address: 5400 Forest; St. <br />Commerce City, CO 80022 <br />Phone Number: (303) 289-1428 <br />Far. Number: <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 />r <br />'?'OCAAaAl) <br />Signature of Corporate CfFlcer, Owner, signee <br />O -90-09 <br />Date