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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNPJERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Siloam Stone <br />M-1997-094 <br />Pinon Mine <br />November 20, 2004 <br />$281.00 (Due on or before your anniversary date) <br />Pueblo <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 <br />during the upcoming year, reclamation that will lie performed during the coming year; the dates for the beginning- -- <br />ofactive operations, and the date active operations ceased for the year, if any. <br />Please attacl~ynnr revised written annual report and anneal report m ~n to Chic form- Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice jor a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ferd A. Mueller <br />Permittee Name: Siloam Stone <br />Address: ~Ivfatt3vfae1leF <br />315 N 7th St <br />Canon City, CO 81212 <br />Phone Number: (719) 275-4275 <br />Fax Number: ~~ti~ n~~, <br /> <br /> <br /> <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 />t~tature~~~tc~ r, or Designee <br />~i/~~%~ <br />Date <br />