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~ n~ ./_ RECEIVED <br />!f 1/ J FEB 12 2001 <br />ANNUAL FE~ and REPORT REQUEST <br />Division of ReGamauon, <br />PERMITTEE NAME: Clyde and Marie Couch Mining and Safety <br />PERMIT NO.: ~I-1989-023 <br />OPERATION NAME: Caliche School Pit ~ ~ <br />ANNIVERSARY DATE: March 9, 2007 ~ ~loa <br />ANNUAL FEE DUE: $$281.00 (Due on or before your anniversary date)Di _ .. ~®~~, <br />COUNTY: Logan ~/°/n~; - <br />v/,4~y ''/ i/ <br />4!.," cry, <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an/operator <br />---shall-sabmit-the-anrmal-t'ee~-r,port-and-map-showing-[he-exter[t-vf-current-dfsturban~cs-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 vour revised written annual resort and annual resort maa 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 chances to <br />the previous year's map are necessary. then no new map is required. provided that the Operator shall state <br />this in the Annual Resort. 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: Clyde Couch <br />W n; ~ ~A'n i ~ LP f <br />Permittee Name: Clyde and Marie Couch w h P... 1,~„? ~,~ ~Q, f '~b 5 - tl <br />Address: 122 State St. ~~ er~ ,~ ~ C 1,e, (~ ti ~ 6}e a <br />~ oG'l'h~ 9y~ea <br />Sterling, CO 80751 a : ~twar ~ U <br />,~~~ ~~ t•`~~16 4 poa ti~i+t s <br />Phone Number: (970) 522-1239 1,~ ~ ~a~ <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 />0~ J~, Amy :~, <br />Signaf~tur~of Corporate Officer, Owner, or Designee <br />~.. 1 60'1 <br />Date <br />