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f <br />? F f <br />AN1?UAFE`E and REPORT REQUEST MCMED <br />PERMITTEE NAME: "top Aquatic Investments, LLC 4-MAR 05 2010 <br />Divieien or keclmnation, <br />PERMIT NO.: t-2004-022 V Afting and Safety <br />OPERATION NAME: Raindance Sand and Gravel Mine <br />ANNIVERSARY DATE: March 4, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: Weld <br />CA, <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 that will be performed during the coming year, the dates for the beginriirig - <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour 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 vear'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: Martin <br />Permittee Name: Hilltop Aquatic Investments, LLC " ?!L t <br />v <br />Address: 1625 Pelican Lakes Pt., Ste. 201 <br />Windsor, CO 80550 <br />Phone Number: (970) 686-5828 -7 ffFax Number: <br /> <br />If you have additional comm;?'ng nd/or info ation that should be provided to the Division, please provide it <br />below or attach it to this form with you written report and map. Annual Report instructions are enclosed. <br />Signature o'C rporatepffizier,er, or Designee <br />Date