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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~~ ~-R~ <br />ANNUAL FEE and RE~PjO~RT REQUEST <br />Hector Rodriquez V <br />M-1999-062 <br />Indio Red Quarry Number 1 & 2 <br />August 23, 2007 <br />RECEIVED / <br />SEP 2 4 2007 ~/ <br />Dlvlsfon of Reclama0on, <br />Mining and Safety vv <br />$323.00 (Due on or before your anniversary date) <br />Larimer <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 />reclamation accomplished to -date and Wiring -the prece mg year, new disturbances fhat 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 vour 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 durinti the previous year and no new chanties 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 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: Abe Vasquez <br />Permittee Name: <br />Address: <br />Hector Rodriquez <br />P.O. Box 122 <br />Phone Number: <br />Fax Number: <br />Lyons, CO 80540 <br />(303) 823-6116 <br />(303)823-6888 <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. <br />a Corporate Officer, Owner, or Designee <br />~'z~-o~- <br />Date ~ <br />