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<br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />r <br />44 F ANN AL FEE acid RE ORT /REQUEST <br />V, Soil Conditioning Company <br />Maverick Placer <br />June 16, 2009 <br />RECEIVED <br />4AY 2 6 M'l <br />?4m <br />Di*itni of Recl@maticm, <br />ID Ml AV and Safety <br />$$791.00 (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 />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 disturbances that are anticipated to occur <br />egmnmg' _ <br />during the upcoming year, reclamation that will be performed during the coming year, t hi dates or t He <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 during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required. Provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Joseph E. Lig le <br /> <br />Permittee Name: S Soil Conditioning Company <br />Address: P.O. Box 926 <br /> Salida, CO 81201 <br />Phone Number: (719) 539-3535 <br />Fax Number: (719) 539-9596 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach ' o this form along with your written report and map. Annual Report instructions are enclosed. <br />gnature of Corporate Officer, Owner, or Designee <br />1av ?, FM 1 <br />Date