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YO <br />? sa <br />AN ALG FEE and REPORT REQUEST <br />PERMITTEE NAME: 7e Fort Lyon Canal Company <br />PERMIT NO.: M-2001-097 qcp <br />Divis <br />OPERATION NAME: Fort Lyon - State Pit No. 1P 2 2010 <br />ANNIVERSARY DATE: October 8, 2010 <br />-?a Diviston u+ 'r«clamation, <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) fining and Salty <br />COUNTY: Bent <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 />_ _. urmg the upcoming year, reclamation that will"be performed-durmg"ie 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 may 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: Manuel Torrez <br />Permittee Name: The Fort Lyon Canal Company <br />Address: 750 Bent Ave. <br />X10 C?nANfnLS (646, IS <br />%-L, D E is a L(L ,a vo'x w M-". ,z ay o x a- <br />Las Animas, CO 81054 or * Mft, <br />Phone Number: <br />(719) 456-0720 <br />?`TttlNAs4 1 tib%- 111,0. <br />Fax Number: <br />(719) 456-1609 <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 cer, Owner, or Designee <br />Date