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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />U S Soil Conditioning Company <br />M-1979-206 <br />Maverick Placer <br />June 16,2002 <br />$688.00 (Due on or before your anniversary date) <br />Fremont <br />RECEIVED <br />JUN 0 6 20~ <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-I 16 or C.R.S. 34-32-116, each yeaz, on the anniversary date of the permit, an operator <br />shall submit ?he annual .fee,- a-.report-and_map,showing_tlae-ezfent_ of-r~rrent disturbances- to~ffected-land,- - _ - <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permi[tee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joseph E. Lionelle <br />Permittee Name: U S Soil Conditioning Company <br />Address: P.O. Box 926 <br />Salida, CO 81201 <br />Phone Number: (719) 539-3535 <br />Fax Number: (719) 539-3531 <br />If you have addit' nal co menu and/or information that should be provided to the Division, please provide it <br />below or attach y [o this fo along with your written report and map. Annual Report instructions are enclosed. <br />- Y~ <br />$~ignature of Corporate Officer or Owner <br />/( vi pz <br />to <br />M iPERMITUTASTERDOCUMENTSUd-AF-01 <br />