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C <br />A AL FEE and REPORT REQUEST <br />PERMITTEE NAME: First Bentonite Company Colorado <br />PERMIT NO.: VF/M-1977-231 <br />OPERATION NAME: LBC Bentonite Pit <br />ANNIVERSARY DATE: August 23, 2009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Fremont <br />bmk ors <br />RECEGvzo <br />4AuG i ?P1nq <br />I?IVf?l?n Ai ?^???m?;icn, <br />MIMI <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 />- - - <br />during the upcoming year, reclamation that wi-`Il be p ormed during the coming year, t ?1^e dates?`or the 'ri'mg <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 vear's map are necessarv. 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: Pamela Wedige <br />Permittee Name: First Bentonite Company Colorado <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 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 enclosed. <br />Signature of Corporate Officer, er, or Designee <br />60 <br />Date