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ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: William & Beverly Caldwell and Albert & Lola Nesselhuf <br />PERMIT NO.: M-1997-071 RECEIVED <br />OPERATION NAME: Caldwell-Nesselhuf Pit No. 1 JUN C'18l ?O t f <br />ANNIVERSARY DATE: June 30, 2011 0htleton of Roolama#IBR, <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) MNng & SA V <br />COUNTY: Crowley <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 />?_ <br />-*'Rwl date.and-dnringTthe preneding year, new disturbances that-are_anticinatcd_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 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 />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year'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: Albert F. Nesselhuf, Jr. <br />Permittee Name: William & Beverly Caldwell and Albert & Lola Nesselhuf <br />Address: 31738 Rd 13 6 t / S A3 D / D e-% iAlq 0d.4- c 0, <br />Manzanola, CO CF.PR.zip_code <br />Phone Number: (719) 462-5236 <br />Fax Number: 1 <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 Co orate Officer, Owner, or Designee <br />? 2 <br />Date