2007-05-30_REPORT - M1979206

• Permit No: M1979206
• IBM Index Class Name: Report
• Doc Date: 5/30/2007
• Doc Name: Annual Fee/Report/Map
• From: DRMS
• To: US Soile Conditioning Company
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

~~~
A ~ 'FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~.IJ S Soil Conditioning Company
~I-1979-206
Maverick Placer
June 16, 2007
~.._ /
~`7r~r X17
'' .abn ~r~ ,~7LU/
(J,irtin ~eiion,
9 and Saf~,y
$$688.00 (Due on or before your anniversary date)
Fremont
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
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land,
reclamation accomplished to date and during-the preceding year; new disturbances that are anticipated to occur- --
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach Your revised written annual report and annual resort map to this form. The Annua- Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new chanties to
the previous year's map are necessary, then no new map is required, provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the
above elements may su~ceJ'or a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes: /~i
Permittee Contact:
~.~
Permittee Name: ~ ~[J S Soil Conditioning Company
Address: P.O. Box 926
Phone Number:
Fax Number:
Salida, CO 81201
[phone]
[phone]
If you have additional cotrnnents and/or information that should be provided to the Division, please provide it
b ow or attach i o is forrn along with your written report and map. Annual Report instructions are enclosed.
. ~-
gnature of Corporate Officer, Owner, or Designee
/ii ~ j ~/ 7
Date