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}~>RP-7- <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />' /Larry Mandragon <br />y M-2002-106 <br />Rio Grande Bentonite <br />September 22, 2005 <br />I"C O <br />~~(~VZy <br />~ ~~~ ~ <br />$281.00 (Due on or before your anniversary date) <br />Conejos <br />According to C.R.S. 34-32.5-116 or~.S. 34-32-116, each year, on the anniversary date of thepermit, an <br />operator shall submit the annual fee, a report and mad showing. the extent ot~current disturbaiic to affected <br />land, reclamation-accomplLSh_ed to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming~+ear, reclamation that will be performed during the coming year, the da~ for the <br />----- --- --_ - - -: - -~ yr_. <br />beginning_of active operations, and the date active operations ceased for the year, if any. ~ <br />Please atfnch ym~r revised written 9nnnel rennrf and anm.al re on rf ma-P fn this form- Please note that an <br />ad~uately labeled man that clearly delineates and includes the above elements may suJ~ce 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: <br />Permittee Name: <br />Address: <br />Larry Mondragon <br />Larry Mondragon <br />9451 U.S. Hwy. 285 S <br />Alamosa, CO 81101 <br />Phone Number: (719) 589-2607 <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 />~> V' <br />Signature o Corpo ate O lcer, Owner, or Designee <br />c~/ lL/~l <br />Dale <br />MAPRRM I'nMASTF.RD(x'.IiMF;Nr5U1-Ar-00 <br />