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Mar UV 1U Ue:bbp I HUMAS SWIN I <br /> <br />1-847-(76-2bOl p.2 <br />ANNUAL FEE and REPORT REOMST <br />PERMITTEE NAME: Avalanche Creek Marble & Alabaster LLC <br />PERMIT NO.: ?M-1"9-042 c/ MAR C13 2010 <br />OPERATION NAME: White Banks Mine I)MMttn of Reclamation, <br />mining and Safely <br />ATINI?IERSARY DATE: January 4, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary elate) <br />COUNTY: Pitkin <br />According to C.R.S. 34-32,5-136 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 performed during the coming year, the dates for the beginning <br />or 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 />man. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the Previous vear's man are necessary, then no new man is rea utred. 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 elerrrarrts may suffice fbr a witten report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: BeR-8&anmietlo- <br />r1omas L. 5wi-nt; <br />Permittee Name: Avalanche Creek Marble & Alabaster LLC <br />Address: P. 0. BOX 277 <br />Pa2atina IL <br />60078-0277 <br />Phone Number: +304-5-545Z4- (847) 358-3834 <br />Fax Number: -(-343pal-6.51)/- (i347) 27fi-260 <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 Officer, Owner, or Designee <br />-2,0.? U <br />Date