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PERMITTEE NAME: Natural Soda, Inc. <br />PERMIT NO.: `4-1983 -194 <br />OPERATION NAME: Nahcolite Project <br />ANNIVERSARY DATE: January 31, 2012 <br />ANNUAL FEE DUE: $1,150.00 (Due on or before your anniversary date) <br />COUNTY: Rio Blanco <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 report and map showing the extent of current disturbances 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: Bill H. Gunn <br />Permittee Name: Natural Soda, Inc. <br />Address: 3200 RBC 31 <br />Rifle, CO 81650 <br />Phone Number: (970) 878 -3674 <br />Fax Number: (970) 878 -5866 <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 />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:\PERMITIMASTERDOCUMENTS/M -AF -02 DOC <br />APP <br />ANNU FEE and REPORT REQUEST <br />r,t <br />j Uiv <br />1 V �.I:; i,lt;O�i <br />