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~~ r'Ii <br />`~ <br />RFC~~VE p <br />Mqy>>~ <br />I'I•RMfI"IFf:\:\\11 Phillips<'ounh• a'n~'0qu/Mmegb~ed <br />oan <br />I'I•R\tfl' \O. fit-20114-U23 <br />c>Pl,k:\'I IC)V \~\\tf.-. Ilavncs Ilcrcfnrd Rnnch Pit <br />:\NKI\'f,ItS:\Itl' D:\ fl .lone 2. 20116 <br />~NM!;11. Phl DI il• ~28L(10 (Doc un nr hefom your anniscnan date) <br />('Ot ~Nl \': Phillips <br />Accrndmg to ('.R.S. 3d-32.E-I 16 or l'.R.S. ;4.32-I I6. rnch year, on the anniversary date of the prrnut• an <br />operator shall submn the annual tic, a report and map shun•ing the extent of cun•cnt disturbances to atlcctrd <br />land. rrclant:niun uccompli,hed kt Jule and during the prrcrdutg yrtr, ne~s di+uuhaner; that arc :uuicipetrd to <br />occur Jurmg the upeurnmg )rte, reclamation that u•dl he pc•rtin'r»ed during the ronung year, the da0.•. Ibr the <br />he}~unune o(actter nperauuns, and the date ^clrvc n~crahon, rca.ed ti+r the arar, tf an\'. <br />i'Iease attach 3uur revised svritlenrnuual report and annual reµ rrL t m:y1 lu [his fnnu_ Pleu.~i• qulr• III~U do <br />;idc•qu;ur(I lah~ (rd m;qr !lt;u r;rarh drlirtrdh~c ~rnJ rarlmL•~ rlr~ ahnrr rk•rocna final' .ctiJ)icc liu a trrirr<•n <br />rrparl <br />Ihctsion records rndieatr the ti~lluwing Ixrmittre contact inlitrnauion. Please certfy and nutkr nny necessary <br />changes: <br />I'rrnnttrr l'ontact: It:uuh- 5chafcr <br />Pcrmittre Name: Phdhps ('aunty <br />:\ddress: 221 S. Intrrucean .4vr. <br />Ilolvokc,l'O So7t4 <br />Phone Number. (97(q 854-3778 <br />faa Kumhcr: (97(I) Ri4.381 I <br />II• you have addluonal atmnxnts and'or mlitrntatum that should be provulyd to the Utrtswn, please pros'Idc tt <br />Ixla~c or attach it Io thi; litrm along wuh your written report and Wrap. Annual Report mstrucuuns arc <br />enclosed. <br />tiignaturr. •C'orymratr (aftiecc Uwnrr, or Designer <br />Date <br />