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09/18/2009 09:11 FAX 7194735494 <br /> <br />PF.RMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />RANCHLAND <br />AN FEF. and REPORT REQUEST <br />g.' nch Land LLC <br />Z-2002-0% <br />Ranch Land Rock pit ##1 <br />October 15, 2009 <br />002 <br />b? <br />bm f l <br />OCT 13 2009 <br />Division of Reclamation. <br />4.0 Klining and Safety <br />$$791.00 (Due on or before your anniversary date) <br />Fremont <br />According to C.R.S. 34-32.5-116 or G.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-thafwill-be performed during the coming year, the dates fo rthe beginning <br />or active operations, and the date active operations ceased for the year, if any. <br />Please attaeh uur revised written annual report and annual re ort ma 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 duria the revious ear and no new changes to <br />the Previous ear's ma are necessarv. then no new ma is r uired provided that the O rator shall state <br />this in the Annnal Re ort. Please note that an adequately laheled 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: William PeCU <br />Permittee Name: Ranch Land LI,C <br />Address: 3925 Hill Circle <br />Colorado Springs, CO 80904 <br />Phone Number: (719) 492-0266 <br />Fax Number: (719) 473-5494 <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 ofCorpo a Ofl er, Owner, or Designee <br />. <br />v7Z-1 <br />Da ge