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A I FEE nd ORT REQUEST <br />PERMITTEE NAME: 7or Rodriguez <br />PERMIT NO.: 999-062 <br />OPERATION NAME: Indio Red Quarry Number 1 & 2 40 <br />ANNIVERSARY DATE: August 23, 2009 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: Larimer <br />CC S <br />,RECEIVED <br />?'AUG 3 i <br />2009 <br />Division of Reclamation, <br />Mining and Safety <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 />- ---- - during-the-upcoming-year,, reclamation-that-xffl-be-performed-daring-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 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: Abe Vasquez <br />Permittee Name <br />Address: <br />Phone Number: <br />Fax Number: <br />Hector Rodriguez <br />P.O. Box 122 <br />Lyons, CO 80540 <br />(303) 823-6116 <br />(303) 823-6888 <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 />7??- <br />igna a of Corporate Officer, Owner, or Designee <br />-7. Z 2 . J <br />Date <br />CE9V <br />AUG 3 ? 2009 <br />Division oi meuainax.ur. <br />Mining and Safety