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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A 4 T <br />ANNUAL FEE and REPORT REQUEST <br />RECEN <br />L I JUN 2 7 2011 <br />/Connell Resources, Inc <br />/fVI- 1998 -058 <br />J Tellier Gravel Pit <br />June 30, 2011 <br />$791.00 (Due on or before your anniversary date) <br />Routt <br />Division of Reclamation, <br />Mining and Safety <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 />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 your 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 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: Larry Johnson <br />Permittee Name: Connell Resources, Inc <br />Address: 7785 Highland Meadows Pkwy., Ste. 100 <br />Fort Collins, CO 80528 <br />Phone Number: (970) 223 -3151 <br />Fax Number: (970) 223 -3191 <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 />l <br />Si atur of Corp <br />Date <br />fficer, Owner, or Designee <br />,fiec`4.n11 TC'n /4 7010 <br />