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RECEIVED <br />MAR 2 Z 1304 <br />ANNUAL FEE and REPORT REQUEST <br />Division of Minerals and Geology <br />PERMITTEE NAME: Silver Mountain Preserve, Inc. <br />PERMIT NO.: M-1992-003 <br />OPERATION NAME: Willis Pit <br />ANNNERSARY DATE: February 7, 2004 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) / <br />COUNTY: Huerfano <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 <br />_ operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach vour revised written annual reuort and annual resort map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br /> i~~G <br />Permittee Contact: Travis R. Crawford <br />Permittee Name: Silver Mountain Preserve, Inc. ~ ~ <br />Address: 11850 CR 520 c~ ~ <br /> ~, k- <br /> La Veta, CO 81055 ~~G' <br />Ph <br />N <br />b 71 <br />742 <br />0210 ~-y <br />~ y - ~ ~2 - `~~ ~ / <br />um <br />er: <br />one ( <br />- <br />9) / <br />Fax Number: (719)868-2416- - - ~'~< <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 />l~~, <br />Signature of Corporate Officer or O er <br />~ - /c -~~f <br />Date <br />2e ~-~,~~~ >~er7ou:N w <br />~e R ~F•J-vim <br />y d-al- ~~' 'Q'dy"r7e.~r <br />~~~~ 1~ h~ - <br />/, <br />~t~ ~ <br />~r ,,~'Nue <br />~~ ~~ <br />C/~a !~ <br /> <br />