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FROM•: C(ICAIS HENDRICKS • PHONE NO. : 303 258 0402 • Nov. 11 1.999 05:02PM P3 <br /> ANNUAL REPORT <br /> PERMITTEE NAME: Hendricks Mining Company <br /> PERMIT NO.: M-77-410 <br /> OPERATION NAME: Cross Mine <br /> ANNIVERSARY DATE: November 03, 1999 <br /> ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br /> COUNTY: Boulder <br /> - According to C-R.S. 34-32-1 W3)(a), each year, on the anniversary date of the permit, an operator shall <br /> submit the annual fee, a report and snap showing the extent of current disturbances to aff:cted land, <br /> reclamation accomplished to date and during the preceding year, new disturbances that w-e anticipated <br /> to occur during the upcoming year, reclamation that will be performed during the coming year, the <br /> dates for the beginning of active operations, and the date active operations ceased for the year, if any. <br /> Please attach Your revised annual report map and written report to this annual <br /> report. Please note that an adequately labeled map that clearly delineates and includes the above <br /> elements may suffice for a written report. <br /> Please type or print the current contact person's name, mailing address, and phone number in the space <br /> provided: `` <br /> Contact Name: I�pt�t�S S. F�t.1b 444-4, Company: t48IGl�S <br /> Adddress: 4•P)DX (e53 Phone No.: <br /> City, State ZIP t4-IYo 1 A9'-1), CbLp Fax No.: (-"303) <br /> If there are additional comments and/or information that should be provided to the Division,please <br /> pr vide it on a separate sheet and attach it to this report form along with your map and/or written <br /> re rt. <br /> a _A01 <br /> Signature of C rporate Officer, or Owner D to <br /> INSTRUCTIONS ON BACK <br />