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-;: ~ IIIIIIIIIIIIIIIIIII r ~C~ <br />~~~ ~ - ~ <br />ANNUAL REPORT ~ lls <br />PERMITTEE NAME: Park County f~~C'~{~i~L7 <br />PERMIT NO.: M-80-252 ; ~~~, ~ 2 L_. I~~rJ <br />OPERATION NAME: Jefferson Flat Pit* Division of Minerals & Geology <br />ANNIVERSARY DATE: Apri101, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $550.00 <br />COUNTY: Park <br />In order to ensure that our records are up to date, please attach your revised annual report map and written <br />report to this annual report. Note that a written report is not necessary if the map addresses all the <br />items listed in the attached instructions concerning mining disturbance and reclamation update. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name: ~PDQERT YA//CE <br />Company:~RKC©un/rY /IyfF,o'~QIQ/pGE <br />Address:: /. ~• ~y 7 <br />~~4/R /'ACA Y Cod o rP~~Q S~'YyQ <br /> <br />Phone No.: ( 7 / 9 1 83 G - 'Y283 <br />Fax No.: ('1/ 9 1 8~ 3 6 - 'Y2 7S <br />b''~.~~1 t•L. er~7 ,c~-,~ st..flar A/~SOt ?of (ar~. Ca~.w7 <br />1 <br />Signature of Corporate Officer, or Owner <br />3 ~' <br />Date <br />M:~DNRht LNt ASTERDNt-AF-Ot. <br />