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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />?- ' r <br />A AL FEE and REPORT REQUEST <br />?jOglebay Norton Industrial Sands, Inc. <br />11 -2006-017 <br />Jemadojin Sand Mine <br />June 13, 2011 <br />$$791.00 (Due on or before your anniversary date) <br />El Paso <br />RECEIV <br />/MAY1?2011 <br />Division of Reclamation, <br />Min:n0 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 />---------reclamati n-acyvl?lished-to-date_-and_during -the preceding _}ear_ 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 durinsE 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: Michael Miclette <br />Permittee Name: Oglebay Norton Industrial Sands, Inc. <br />Address: 3250 Drennan Industrial Loop <br />Colorado Springs, CO 80935 <br />Phone Number: (719) 390-7969 <br />Fax Number: (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. 'a n: A ature of Corporate ficer, Owner, or Designee <br /> <br />Date