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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />AN REPORT REQUEST <br />'Mesa Sandstone, LLC <br />/I~I-2006-009 <br />Hindmarsh Sandstone <br />Apri128, 2007 <br />$$688.00 (Due on or before your anniversary date) <br />Montezuma <br />F~'~E~'. _'~' <br />'' ApR 2 3 2001 <br />Division otand SatetYan <br />/Mining <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 />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new d_isturbances_that are_anticipated to_occur <br />_ - - during'the upcoming year, ieclamatioii that wilt 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 durinc the previous Year and no new chances to <br />the previous year's maa are necessary, then no new maa is required, provided that the Oaerator shalt state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Please note Principal contact, Mailing address, and Phone contact changes. <br />Pennittee Contact: ^^-°-~.,.. e•,~.s:,~° --~ William K. Goode, Manager <br />Permittee Name: Mesa Sandstone, LLC <br />Address. 24600 Cnnn~RnarL <br />-~ Pest Office Bex 22Q <br />Cortez, CO 81321 <br />Phone Number: io~m c~c ozn~ <br />~---T---~----~~ (970) 565-1167 <br />Fax Number: ro~n~ cFC_o~na <br />~--~ (970) 565-1167 <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 Rep/ort instructions are enclosed. <br />72 1 IAM K.~G O E, MdNA_GER <br />Si afore of Corporate icer, O ner, r Desi ee <br />Dat~[prii~~~80 __ <br />NUAL ~ and <br />