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1 <br />N`~ / <br />A F ~!r R~T- <br />ANNUAL FEE and REPORT REQUEST <br />RECEIVED <br />PERMITTEE NAME: San Miguel County <br />/ NOV 09 [~~l <br />PERMIT NO.: M-1981-220 `~ <br />OPERATION NAME: Klondike Pit Division of Reclamation„~ <br />Mining and Safety <br />ANNNERSARY DATE: November 20, 2007 <br />ANNUAL FEE DUE: $$791.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <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 report and annual report maa to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinti the arevious year and no <br />new chanties to the urevious year's man are necessary, then no new man is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mike Horner <br />Permittee Name: San Miguel County <br />Address: P.O. Box 426 <br />Norwood, CO 81423 <br />Phone Number: (970) 327-4835 <br />Fax Number: (970) 327-4090 <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 <br />enclosed. <br />/~! L!//rlii~i~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />~1~~~ 7 <br />Dat <br />M:~PERMITMASTERD000MENTSU9-AFA4 <br />