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l'I;.~iZ <br />' S5S REC~IV[ l) <br />MAR 2 X006 <br />~\VI Al F'4:1•: and I(L:I'OK'1' [tF:OUF:5'1' <br />1'I(R~dll fl'L• N:1M1 i llldrastlc SW Uraup. Ine. dhu I nitrd <'nmpanics of ~lcsu ('uunly <br />I'I R~1f 1' NO.: ~I-1977-0211 <br />UI'IiKAI lON `AMI;: 1'it \o I <br />ANN14'1J(SAl(Y 1)AI'L' March 23, 21111x, <br />ANNU.AI I I:I~ 1)I tl . '~hRR.llll lUur on or brfnre your unoiccnun daft) <br />COUN'Cl": Ilrltu <br />,lcamlrng to l'. k, S, td-i2j.l IG or ('.I(.S. 14-12-I 16, such year, on rhr anniversary daft o(thc permit, un uperawr <br />shall suhmd the annual fcc, a report and map shnwing the c~tcnt of current dtsturbunres w altcctrd IanJ, <br />rrclamatu+n acaxnplishrd to dart and ctunng the pr.-ccdtng }-car, new disturhun:rs that un anueipulyd U+ +KCUr <br />dunng the upcumin~ arar, reclamnuun that w ill hr performed dunng rhr curnurp year. the d;urs fur the txgummg <br />of urn~r +qu•rourm., and tl:c date acuar uperauun. rrasrd fur rhr year, if;uty <br />1'Icrce nltneh ~mr revi.r t wrist •n annual relmrl and ennual relmrt nurp to [hie L+rm. I'Irifu• gore lGul urr <br />odcyu;nrlr hrbrlrJ nrrrp rlrrrr rfrv+r(r drlinwrn•c .nu! iorlu;l~. the a6nre clcvn~'nh oun +ulli~ + h,+ ;r rrriUrrt report. <br />Division rc~ord utdiratc• rhr litllowmg pcrmittce contact informatwn. Please verify and make any necessary <br />changes: <br />Prrmutrr ('ontuct: Nrcnt 1V. Kerr <br />Pennittrc Numr: Oldcasllc ti\V Group. Ina dba United ('ompamrs of h1rsa ('ounty <br />Addrc,: I'.O. Bo.r 1GU9 <br />(;rtnd Junction. t'O RI S(12 _ <br />I'hune Number. 197(11 2J3-491111 <br />Pox Numlxr: (9701 241-9945 <br />II vuu hour addnional comments and~or inti~rmalron that should be pnrculcd to rhr I)ivuiun, please pru>,idr n <br />below ur attu:h it a, this li~rm along w uh vour wnttrn report and map. Annual Keport mstnrctimu are cncloxd. <br />_+_ <br />- l ~ <br />Signature ofCorparutr Officer. Owner, nr Uesigncr <br />I)alr <br />