GENERAL45709

• Permit No: M1979206
• IBM Index Class Name: General Documents
• Doc Date: 8/15/2006
• Doc Name: Fax request - annual fee form
• From: DRMS msr
• To: U.S. Soil Conditioning Company
• Permit Index Doc Type: General Correspondence
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
U S Soil Conditioning Company
M-1979-206
Maverick Placer
June 16, 2006
$688.00 (Due on or before your anniversary date)
Fremont
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-1 16, each year, on [he anniversary date of the permit, an operator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual report maa to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffrce for a written report.
Division records indicate the Following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Joseph E. Lionelle
Permittee Name: U S Soil Conditioning Company
Address: P.O. Box 926
Phone Number:
Fax Number:
Salida, CO 81201
[phone]
[phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
Signature of Corporate Officer, Owner, or Designee
Date