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(,t~~,a <br />ANNITAi. FF,F, and RF,Pt1RT RF,OiiF.ST <br />PERMITTEE NAME: ;% Jerry Johnston <br />PERMIT NO.: ~M-1982-044 <br />OPERATION NAME: _ _ .. Glen Johnston Site 1 <br />RECEI!/E® <br />w~ <br />APR 11 2006 <br />~rision of Minerals and GeelolfY <br />ANNIVERSARY DATE: April 23, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Teller <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 year, new disturbances that are anticipated to occur I <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 fir revised written annual rennrt and annual re~nrt main to this form- Please note that an <br />adequately labeled map, that clearly delineates-and includes the above elements tlray since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jerry Johnston <br />Permittee Name: Jerry Johnston <br />Address: 13800 Hwy. 24 <br />Phone Number: <br />Fax Number: <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 />r afar f Cod orate Officer, Owner, or Designee <br />~^ / n ~D <br />Date <br />Divide, CO 80814 <br />(719)687-9043 _ <br /> <br />