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AOG-17-2070 07:124!1 FROM-CIV ,PELLAMIATIOH HIRING & SAfE7Y 3038328102 T-002 P 002/tl04 F-002 ~~~ I <br />a a3o,6 ; <br />~~ <br />ANNUAL FE_E and REPORT REOUFST <br />PERMlTTEE NAME: ~ U,S Soil Conditioniug Company ~ ~ ~ ~ I ~~ <br />PERMIT NO.: ~M-1979-206 /~AUG Z 1 2006 <br />DPERATTON NAME: illaverick Placer / U+vision of ReGamation, <br />ANNIVERSARY DAT&: Juue 16, 2006 Mining and Safety <br />ANNUAL FEE DUE: $688.00 (Due on or before your auuivcrsary date) <br />COUNTY: Fremont <br />According to C.R.S. 34.32.5- I l6 or C.R.S. 34-32.116, each year, on the anniversary date of the permit, an operator <br />shall submik-the annual-fee,--a report and map showing the ex[enrof currem disturbances to affected land, <br />reclamation accomplished to dace 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 moo to this form, Please note that an <br />adequately Labeled map that clearly delrneotes and includes the abort elemenu may since fnr a rvrih'en report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Petmittee Contact: Joseph E. Licnelle <br />Permittee Name: U S Soil Conditioning Company <br />Address: P.O. Box 926 <br />Salida, CO BI201 <br />Phone Number. (719) 539-3535 <br />Fax Number: (719)539-9596 <br />if you have additional ments_and/or_infotmation,tltat_should be_provided to the Division, please provide it <br />belotygr attach it to t ' fojm along with your written repon and map. Annual Report instructions are enclosed. <br />• ~ U/ <br />~t(+ature of Corporate O~cc;r, Owner, or Dcsiome+ <br />Date <br />