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~n <br />~o i3 -off, <br />~GcJ- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIV ERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />v ANNUAL FEE and REPORT REQUEST <br />j/ /Nalco, Inc <br />M-2004-043 <br />Nalco T Pit <br />October 19, 2006 <br />$688.00 (Due on or before your anniversary date) <br />Las Animas <br />RECEIVE® <br />`' nr.T i ~ ~nn6 <br />~~ Divrsron of Reclamation, <br />Mining and Safeq~ <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 permitan operator _ <br />--- shall' subutii Cfie annual-fee; a reps and- reap showing t~ ezterit-of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new 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 Report <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 map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />__-Division-records-indieate-the-following permitte~cartact in-for~~o' n Please verify an ma a any necessary <br />changes: <br />Permittee Contact: ~~~ ~~~.~ ° ° w t <br />Permittee Name: Nalco, Inc <br />Address: 200 S. 17th St. <br />P.O.Box 550 <br />Rocky Ford, CO 81067 <br />Phone Number: -1i~-1.9}~5d~64 '7 ! q _ 02 5 t{ _ ~ y Col <br />Fax Number. f"' ^` ^ <<~4-:4b8 -- I ~ - o"~ 5 y _ -7 y (e ~ <br />~~ ~i <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 aze enclosed. <br />Signature of Corpor to Officer, Owner, or Designee <br />9zaa6 <br />Date <br />