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J-~- <br /> AF ~ ~~ <br /> ANNUAL FEE and <br />R <br />EPORT REQUEST <br /> ~ <br />Q~ <br />PERMITTEE NAME: Jack Clark Jr. <br /> / <br />PERMIT NO.: M-2005-065 <br />OPERATION NAME: Upper Animas Sand and Gravel Pit <br />ANNIVERSARY DATE: December 8, 2007 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: San Juan <br />RECEIVED / <br />NOV 0 9 2007 `~ <br />Division of Reclamation, <br />Mining and Safety <br />According to C.R.S. 34-32.5-1 l6 or C.R.S. 34-32-1 16, 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~o_date and~uring the_preceding_year,~ew 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 Repots <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 vear and no new chanties 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 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: Jack Clark Jr <br />Permittee Name: JacKClark Jr. U <br />Address: P.O. Box 767 <br /> Silverton, CO 81433 <br />Phone Number: (970) 387-5243 <br />Fax Number: tCAX: 970 -3ar- ~~ z I <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 />~~~~Gf~iL Lila ' <br />Sig1 y e of Corporate Officer, O er, or Designee <br />.iYOVdrtsE2 ~- Zoo7 <br />Date <br />