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Te <br />~r~i~f`~PRP?'°q <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Joseph L. Dorris <br />M-2003-030 <br />Glacier Peak Mining <br />June 30, 2005 <br />JUh! 0 ~ 2C05 <br />L~ritwh u. i •1..:c: als Yu Ba~ioOY <br />$225.00 (Due on or before your anniversary date) <br />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 <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <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 attachynnr revised written annnal report and annual report m n this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice 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: Joseph L. Dorris <br />Permittee Name: Joseph L. Dorris <br />Address: 2920 Cedar Hts. Dr. <br />Phone Number: <br />Fax Number: <br />Colorado Springs, CO 80904 <br />(719)685-4479 <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 />~~-~ <br />of Corporate Officer, Owner, or llestgnee <br />r7 Jul Zao 5 <br />Date <br />M:~PERMTT~MASTERDOCUMEMS~M-AF-02.DOC <br />