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~w.~rt <br />~~~r 4hP <br />ANN'[I~IL FEE and REPORT REQUEST t~ '-' ,-. - - - <br />PERMITTEE NAME: Sanborn Sand end Gravel ~~~ ~ 8 2005 <br />PERMIT NO.: M-1984-1194 Division at Minerals f ;.;olnay <br />OPERATION NAME: Gloria Z Mine <br />ANNIVERSARY DATE: Jaiy 17, 2002 <br />ANNUAL FEE DUE: $6g8.00 (Dme on or before your anniversary date) <br />COUNTY: Park <br />S <br />According to C.R.S. 34-32.5-] 16 or C.R.S. 3432-I 16, each year, on the anniversary date of the permit, an operator <br />- --shall-submit the annual-fee,-a report and- map showing-the eztenf of-current-disturbances-to-affected-~and~ - <br />reclatnation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates atul includes the above elements may suffrce for a written report. <br />Division records indicate the following permittee contact information. Please verify acrd make any necessary <br />changes: <br />Permi[tee Contact: Saadra.$~bat+r <br />Permittee Name: Sanborn Sand and Gravel <br />M: C Q a e ( fir :S~ pu <br />Address:>~..:~p...~-3oi p Or ~°~& O <br />i! ~~11r ~/ 0 8o r/„Z ~ <br />Fairplay, CO 80440 <br />Phone Number: r{~}9~~36f2dtRr 9 70 38 `~ 7 t) ~ 6 <br />Fax Number: - .119}836-~IA6=- -' ~ - 7-/ 9 ~ .i ~ Off V-~ - _ <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 fore along with your written report and map. Annual Report instmctions are enclosed. <br />X <br />Signature of Corporate ficer or Owner <br />7 / /,~ ,~6 <br />Da~ 7 <br />M:IPERMlnMASfEitDOCUMENTSM-AFOI <br />