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~, a~~ <br /> <br />~ECErvEo <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Natural Soda, Inc. <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 />---lan , rec ama ron acco p fished-to date and during-the preczding-yearnew-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 ynnr revised written annual rennrt and annual report m to this form- please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ed Baker <br />Permittee Name: <br />Address: <br />3200 CR 31 <br />Natural Soda, Inc. <br />M-1983-194 <br />Nabcolite Project <br />January 31, 2004 <br />JAN 2 9 2004 <br />blyftloh of Minerals & Geology <br />$550.00 (Due on or before your anniversary date) <br />Rio Blanco <br />Rifle, CO 81650 <br />r --Phone Number-(970}-878=3674 <br />Fax Number: <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 />.~~~~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />~~ ~~ <br />Date <br />IJ/~ <br />M:\PERMITMASTERDOCUMEMS/M-AF-02.DOC J <br />