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r1Fi`r'-2 -201 r_, 03 : 34 PM 0.?+ <br />s?e <br />UAL wAd POR QUEST <br />PERMITTEE NAME: ?aldwell Brothers <br />PER-MIT NO.: 4-1986-016 V <br />OPERATION NAME: Caldwell Brothers 3 _ /?Divlslon of Reclamation <br />ANNIVERSARY DATE: June 1, 2010 `P V" -* P, <br />ANNUAL FEE DUE: $,$791.00 (Due on or before your anniversary date) <br />COUNTY: Otero <br />P.. 0 2 <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 reportand map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, .new-disturbatces. 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 />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised writt n annual report and annual report m to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee report, and associated <br />9L&R. If no new disturbances or reclamation have occurred during the previous Year and n2 new chan& tQ <br />the previous year's chap are necessary then no new map is required provided that the Operatgr 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Wayne Caldwell <br />Permittee Name: Caldwell Brothers <br />Address: 25026 Rd 19 <br />Rocky Ford, CO 81067 <br />Phone 'Number: (719) 254-3210 <br />Fax 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 />Signatur of Corporate Officer, Owner, or Designee <br />d 7- a-0/ D <br />Date