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M~- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A~ ~ RPT <br />ANNUAL FEE and REPORT REQUEST <br />Larry Mondragon t/ <br />M-2002-106 <br />Rio Grande Bentonite <br />September 22, 2007 <br />RECEIVED <br />SEP 212007 <br />Division of ReGamatlon, <br />Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Conejos <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 permit, an <br />__-_._-oneratnr shall.-submiLthe-annual-fee,-a-report-and-map-showir!g-the-extent-of-current-dish.~rbances to-affected ----- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual renort and annual renort mao to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated man. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the nrevious year's man are necessary, then no new mao is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Permittee Name: <br />Address <br />Larry Mondragon <br />Larry Mondragon <br />9451 U.S. Hwy. 285 S <br />Alamosa, CO 81101 <br />Phone Number: (719) 589-2607 <br />Fax Number: <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 are <br />encl°Q~ed. <br />~../~ <br />Signat~re of r oral Officer, ner, or Designee <br />Date `~~ a-40 7 <br />MIPERMITU.fASTERDOCUMENTSNI-AF-04 <br />