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Dec 21 11 11:06a <br />PERMTTTEE NAME: <br />PERMIT 'NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />THOMAS SWINT 1- 847 - 776 -2601 p.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 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 />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 man 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 Thomas L. Swint <br />Permittee Name: <br />Address <br />Avalanche Creek Marble & Alabaster LLC <br />P.O. Box 277 <br />Palatine, IL 60078 <br />• <br />Phone Number: (847) 358 -3834 <br />Fax Number: (847) 776 -2601 <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 Corporate O cer, Owner, or Designee <br />/- 3 - <br />Date <br />4 � PORT A NNti AZ FEE and REQUEST <br />Q <br />,P- Avvalanche Creek Marble & Alabaster LLC <br />"11'I-1999 -042 <br />White Banks Mine <br />January 4, 2012 <br />$323.00 (Due on or before your anniversary date) <br />Pitkin <br />RECEIVED <br />liAN 0 4 2012 <br />ivision of Reclamation <br />Mining & Safety <br />