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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />I' <br />7 <br />k.I, FE and REPORT REQUEST <br />- ` The Turquoise Connection, Inc. <br />/M-2007-031 <br />Scott Blue II <br /><30 <br />RECEIVED <br />JUL 0 6 [009 <br />Dawirn of t3e®latIS&A, <br />MWO* nd Safeiyp <br />July 5, 2009 <br />$$259.00 (Due on or before your anniversary date) <br />Teller <br />maps beach year, on the owing the extent annicurreversary date of the <br />disturbanceperm <br />to affected <br />According to C.R.S. 34-32.5-116 or C.R.S. <br />operator shall submit the annual fee, a report an <br />land, reclamation accomplished to date and during thellpreceding year, new disturbances tha are <br />erormed duri g the coming yeartthe datesifor theo <br />occur during the upcoming year, reclamation that P <br />beginning of active operations, and the date active operations ceased for the year, if any. nnual Please attach our revised written annual report ave received the following his form. <br />and <br />Report & Fee requirement is not met until w <br />. _L__...... ,.,...o..i-amatinn have occurred during the previous year and no <br />new changes to the revious ear's ma are nuccaaa¦ °?- <br />Operator shall state this in the Annual Report uffPlease o e that n an adequately labeled map that clearly <br />delineates and includes the above elements may f <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Foster G. Scott <br />Permittee Name: The Turquoise Connection, Inc. <br />Address: 910 Phay Ave <br />Canon City, CO 81212 <br />Phone Number: (719) 315-2213 <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 />enclosed. <br />Signature of Corporate is r, Owner, or Designee <br />--7 a - 2 O'er <br />Date <br />M:IPERMTTIMASTERDOCUMENTS/M-AF-02.DOC