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AP- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />t Z ? ANNUAL FEE and REPREQUEST <br />e Turquoise Connection, Inc. <br />M-2007-031 <br />Scott Blue II <br />July 5, 2011 <br />RECEIV <br />N 17 2011 <br />11 i si ofReclamation, <br />7 <br />/'' Mini ning <br />$$259.00 (Due on or before your anniversary date) <br />Teller <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 <br />-operator shall submit-the-annual fee; a-repe:-t and man-showing the-extent of--currentAisturbances to affected - <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map If no new disturbances or reclamation have occurred during the previous year and no <br />new changes to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Foster G. Scott <br />Permittee Name: The Turquoise Connection, Inc. <br />Address: 910 Phay Ave <br />Canon City, CO 81212 <br />Phone Number: <br />Pax hlq) 2s8-9790 <br />1?1R) 32o - 19 ?3 <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 <br />enclosed. <br />- i" - - <br />Signature of Corporate Officer, Owner, or Designee <br />(P -- (G - zQ?/ <br />Date <br />M:\PERMIT\MASTERDOCUMENTS/M-AF-02.DOC