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~~ i <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />~c~ <br />ANNiJAi, FF.F, and RF,PnRT RFQITF.ST <br />,/ Noland, Inc. <br />;/ M-1994-108 <br />Cedar Point <br />March 7, 2006 <br />RECEBVE® <br />`'MAR 0 6 2006 <br />vision of fNieerels end 6eebSY <br />$688.00 (Due on or before your anniversary date) <br />COUNTY: Montezuma <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 />,.,..,...,......,.. ,....,.,...r ............. ....... ..............6 ..,., r..,.,.,.....b ~....., .,.,.....~.....,........~ .......,.., .......,.e....,...., ...,..... <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 vrnur revised written anmlal report and anmlal re nn rt manrtn this form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />PermitteeContact: RiekNoland <br />Permittee Name: Noland, Inc. <br />Address: 40325 St. Hwy. 160 <br />Mancos, CO 81328-8976 <br />Phone Number: (303) 533-7557 <br />Fax Number: (970) 533-7099 <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 Corporate Officer, Owner, or Designee <br />3'~ I - <br />Date <br />