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<br />~`~E~EI~/E® <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Persolite Products, loc. <br />M-1977-319 <br />Swallow Perlite Mine <br />November 22, 2003 <br /> <br />:,.ion o£ Minerals and Geoloa~~ <br />$225.00 (Due on or before your anniversary date) <br />Cusker <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 <br />operator shall submit the annual fee, a re op rt and map showing the extent_of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual rennrt and annnal re~nrt manrn this form- Please note that att <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Michael J. Steiner <br />Permittee Name: Persolite Products, Inc. <br />Address: P.O. Box 505 <br />201 S. Robinson <br />Florence, CO 81226 <br />- _. Phone_Nttmher:______(719),84_6531---.- - -- -. -_- -- -- - - -- - - - - _ - <br />Fax Number: (719) 784-4855 <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 <br />enclosed, <br />Signature of Corpora Officer, Ownet, or Designee <br />AlO/. i8. zoo '3 <br />Date <br />MiPERM(rIMASTER DOCOMENTS/M-AF-@. DOC <br />