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~~; ~~r <br />ANNUAL FEE and REPORT REQUEST <br />PERMTITEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ First Bentonite Company Colorado <br />,/M-1977-231 <br />LBC Bentonite Pit <br />August 23, 2007 <br />/,~~ DK <br />RE~E-~E~ <br />AIIG 0 ~ 2001 <br />pwision of Rec~amation, <br />1/ Mlning and Safety <br />$323.00 (Due on or before your anniversary date) <br />Fremont <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 resort and annual reoort map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, reoort, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous year and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Oaerator 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Pamela Wedige <br />Permittee Name: First Bentonite Company Colorado <br />Address: 215 Teller St. <br />Salida, CO 81201 <br />Phone Number: (719) 539-4693 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide <br />below or attach it to this Form along with your written report and map. Annual Report instructions are enclosed. <br />~'1e..~~~ ~~# rS;~~.-.. c. ~~~J.~h..r. ~ iJ ~c'C~~~~. <br />Signa^^ture of Corporate` Offic Owner, or Designee <br />~J~1IO,~'I!'S~i <br />Date <br />