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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <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 <br />— operator-shall-submit-the annual -fee, areport- and- map-showing- the- extent-of- current disturbances to- affected -- -- -- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: <br />Permittee Name: Nuvemco, LLC <br />Address: 65$ L Ave. <br />B <br />Phone Number: {3163)143=9686 <br />Fax Number: (904)-2-1 <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 <br />enclosed. <br />67 E"MS" u-c OS M b y ? SVtc16V ,T! K4+v. 6 <br />Si natu e of orate Officer, Owner, or Designee <br />I )'Zr) I I <br />Date <br />MA PERMIT TERDOCUMENTS/M- AF -02. DOC <br />ANNUAL FEE and REPORT REQUEST <br />Nuvemco, LLC <br />/M- 2008 -050 <br />October Ore Pile Reclamation <br />August 20, 2011 <br />$518.00 (Due on or before your anniversary date) <br />Mesa <br />5 <br />.Ac-o( 3 b. £'5- <br />25 CAW Ti F•TRL VIFvi DQ11 � <br />%,o _ co 803o3 <br />303 bb, - 52- <br />7zo 4 74.7p <br />RECEIVED <br />- AUG 1 9 2011 <br />Division v, ■'tctamation, <br />Mining and Safety <br />