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ANN AL FEE and REPORT REQUEST <br />PERMITTEE NAME: S Soil Conditioning Company <br />PERMIT NO.: M-1979-206 <br />OPERATION NAME: Maverick Placer <br />ANNIVERSARY DATE: June 16, 2010 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br /> <br />Dive wn of ?Wc,amvAon, <br />Wning snd Sa%tY <br />COUNTY: 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 accom lished to date and during the precedinyear, 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 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: <br />Permittee Name: <br />Address: <br />Conditioning Company <br />Salida, CO 81201 <br />Phone Number: <br />Fax Number: <br />If you have additio <br />beldw or attach it to <br />(719) 539-3535 <br />(719) 539-9596 <br />ents and/or information that should be provided to the Division, please provide it <br />along with your written report and map. Annual Report instructions are enclosed. <br />of Corpora e Officer, wn , or Designee <br />J? UN 10 2010 <br />V (O?-to <br />/^ Date <br />P.O. Box 926