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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Park County <br />M-1980-012 <br />Valley of the Sun <br />April 1, 2004 <br />'\~ <br />'~~ <br />MAR 3 0 2004 <br />Division of Minerals & GeoloBY <br />$281.00 (Due on or before your anniversary date) <br />Park <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 ynnr revised written anmral report and annnal rennrt m ~n to this form- please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Doug Keith <br />Permittee Name: Park County <br />Address: P. O. Box 147 <br />Fairplay, CO 80440 <br />Phone Number: (719) 836-2771 <br />Fax Number: (719) 836-4275 <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 <br />enclosed. <br />Si ature of Corporate Officer, Owner, or Designee <br />~29~D4 <br />Dafe <br />M:IPERM171MASTERDOCUMENTSNr-AF-04 <br />