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)hp,!)l.,l~ <br />~ 1\N1 ,11. F'F'F' and kF'1'Ult'1 ItFO1 Ftil <br />PI•ItMI'CI I Ii NAME: Pork tbunh <br />1'I•.kA11'I NU.: ~I-I9A11-1112 <br />OI'hkA'I'IUN NAME: ~'ullcv ol'Ihc tiun <br />AVXIVI'K5.4kY DA'lli: April I, 21)06 <br />ANNI!AI I IJI I ri'I : 0281.011 IDue on or before yonr unnicersary dote! <br />CC)l1N l'ti', Park <br />:lceurdm); txt ('.R.S. 34.32.5-IIb or l'.Ii.S. ?4.32-I I6, each year, on the anniversary date of the perntl4 tin <br />operator shall suhmn the annual Ice, a rclxLrt anJ map showing the cxtrnt of current disturbances to aflcelcd <br />land. rcel:tmlaion accomplished Ur date and during the prcccding scar, new dl.nuhanccs that arc anticipated u, <br />occur during the upcammg year. rcclamaUon that will ht performed durng the annnrg year. the dates tirr the <br />Ixglnning uiactive operations, and the date active operations ceased fur the year, d'any. <br />f'Icaae uttuchy,nur revi\ed wril(rn annual report •rn+l ~+I++~,+~rpnrt m:~ In rhft loon- P/cu.\r rule' Zhu! uu <br />ndrllalurh luhrlrJ wup tiro! rlrurlr drlinrut~~a unJ rnrlurlc~ thr uh/n•t rlrn+rnrc alut• .Lnl)irc Jar a rvril(en <br />rrln lrl. <br />Division records indicate the ti,lluwing prrmittre contact intitrmation. Please verity and nroke any necessary <br />changes: <br />r~ ~ <br />Perrnlttee ('antnec ancc /~3i'f/~ r~/l~L ~ Tf~__.y1~N c- <br />I'crnuttu Name: Park ('aunty <br />Address: P.U. Box 147 <br />ralrplay. ('o st)44o <br />Thane Numbw: (7191 S ~ .. B ~ ~ yZ~3 <br />I•a.x Number: 1 i 19) R36-0275 <br />11 you have additional comments andior mtilrntatiun that should be provided to the Uivlsarn. please pruviile it <br />below or attach rt to this IirlTrl along with your Lvntten report and mop. Annual Report instructions :ur <br />enclosed. <br />SiFm rc of 'orpm•atcZ3i leer, ULVncr. or Designee <br />~-/7-b~ <br />D~t~ <br />I'PN\1i I ~Af U 1 t~111F N IiM1~.N iti \I-AF~tM <br />