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<br />PERMITTEE 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, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Fremont <br />RECEIVED <br />Jl1L 2 31003 <br />Oirisian ~f Minerals and Geology <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 />shalt-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 vnur revised written annual report and annual report martn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for n written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Petmittee Contact: Pamela Wedige <br />Permittee Name; First Bentonite Company Colorado <br />Address: 215 Teller St. <br />Salida, CO 81201 <br />~~~~ ~av~'~v~~ <br />Ca\S ~~~~- S~ <br />~jct~~ ~ G1.~,~ <br />C ~ ~~~ <br />~PJtone Number:_ _--L7)2)~39~693 1. ~_~~J 3~ _ ~6 `~ -_ ---- J <br />Fax Number: <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 Officer, Owner, o ignee <br />Date `-I_-"- <br />M iPERMITU4ASTERD000MENTSU1-AF-0I <br />