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AF ?Qfl-t' <br />ANNUAL FEE and REPORT REQUEST Fwaven <br />PERMITTEE NAME: Sandco Inc <br />PERMIT NO.: / M-1986-165 AUG 0 2 X010 <br />? pivAsion of f`"i;i m*Non, <br />OPERATION NAME: Willow Bend MinhV and Safety <br />ANNIVERSARY DATE: August 27, 2010 <br />ANNUAL FEE DUE: $323.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <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 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 since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: David D. Dillon <br />All <br />Permittee Name: Sandco Inc ?// 0 P44M?C' <br />Address: P.O. Box 4440 &C 4 'D <br />Durango, CO 81301 <br />Phone Number: (970) 247-1303 <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 t 's form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />f 7- 7 - v <br />Date