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PERMITTEE NAME <br />PERMIT NO.: <br />'0 "6 7 <br />ANN #AFEE"ja d PORT REQUEST <br />Terracing <br />?uler <br />1995-095 <br />OPERATION NAME: Simla Highway Pit r D <br />ANNNERSARY DATE: July 8, 2009 ?(? <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: El Paso <br />Lmk- 0)6-- <br />RECEIVED <br />111JUN 16 2009 <br />Division of Reclamation, <br />Mining and Safety <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-during the= preceding , rmew-distarbances-that are-unt-icipated -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 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 during the previous year wind no new changes to <br />the previous vear's man are necessarv. then no new man is reauired. 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: Henry A. Schuler <br />Permittee Name: Schuler Terracing <br />Address: 510 Caribou St. <br /> P.O. Box 398 <br /> Simla, CO 80835 <br />Phone Number: (719) 541-2396 <br />Fax Number: (719) 764-2659 <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 />Signature of orporate Officer, Owner, or Designee <br />Date