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PERMITTEE NAME: <br />PERMIT NO.: <br />OP1 RATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Ac 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 />sha I 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 />dung the upcoming year, reclamation that will be performed during the corning year, the dates for the beginning <br />of ctive operations, and the date active operations ceased for the year, if any. <br />Pte l e attach Your revised written annual report and annual report map to this form. The Annual Report <br />& ) ee requirement is not met until we have received the following components: fee, report, and associated <br />map. 1f 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 />Di records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Fred J. Orr <br />Pe ittee Name: Baculite Mesa, LLC <br />Ad ress: 5040 Acoma <br />Phone Number: <br />F <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 />Number: <br />Denver, CO 80216 -2010 <br />(303) 295-1313 <br />(303) 295-1256 <br />Corporate Officer, Owner, or Designee <br />/6J <br />(' A NNUAL FEE and REOUEST <br />N Baculite Mesa, LLC <br />-1997 -411 <br />Baculite Mesa Pit <br />July 9, 2011 <br />$$791.00 (Due on or before your anniversary date) <br />Pueblo <br />o►� <br />b,kS <br />RECEIVED <br />JUL 0 5 f 4--J <br />migt01i of Reclamation, <br />Mining Safety <br />