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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />1 <br />A. AL .d fPfIRT REQUEST <br />?0' g lebay Norton Industrial Sands, Inc, <br />,`2006-017 <br />Jemadojin Sand Mine <br />June 13, 2010 <br />$$791.00 (Due on or before your anniversary date) <br />El Paso <br />X <br />JUN 0 7 2010 <br />Division of Rmd2rnajj0n, <br />Hnirag 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 will 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 during the previous year and no new changes to <br />the Brevious year's map are necessary, then no new map is provided that the Operator shall state map are necessary, then no new map is provided that the Operator shall state <br />this in the Annual 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: Michael Miclette <br />Permittee Name: Oglebay Norton Industrial Sands, Inc. <br />Address: 3250 Drennan Industrial Loop <br />Colorado Springs, CO 80935 <br />Phone Number: <br />Fax Number: <br />(719) 390-7969 <br />(719) 390-5517 <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, Owner, or Designee <br />Date