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<br />YERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />First Bentonite Company Colorado <br />M-1977-231 <br />LBC Bentonite Pit <br />August 23, 2002 <br />RECEIVED <br />J~lL 2'9 Z~2 <br />Division of Minerals and Geology <br />$251.00 (Due on or before your anniversary date) <br />Fremont <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 operator <br />--shalt-subrrdt'the annual-fee;-a report-anct-map-showing-the-extent-of-current-disiurbanees-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 vour revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly 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: Paula Wedige ~cti.vn ~\o- ~~~ vq ~ <br />Pettttittee Name: First Bentonite Company Colorado J <br />Address: 215 Teller St. <br /> Salida, CO 81201 <br />Phone Number: (719) 539-4693 <br />Fax Number: <br />If you have additional comments and/or information that should be provided [o the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instmctions are enclosed. <br />~0.nrwoQ ~. A o <br />Signature of cC~orporate Officer or O er <br />M:~PERMI7IMASTERDDCUMENTSVN-AF-OI <br />