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A~; kPr <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~ Ron Ebberts <br />PERMIT NO.: /M-1980-038 <br />OPERATION NAME: Disappointment Valle <br />ANNIVERSARY DATE: October 1, 2007 <br />ANNUAL FEE DUE: $$323.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <br />RECEwED <br />.~ ~~ ~ ~ ~~ <br />Np1ou of Ram <br />tditdn9 a~+d Y <br />According to-ER:S. 34-32;5-116 orC-:R:S-34=32=1-1-6; each'year; on the anniversary da-te of the permif, 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 be performed during the coming year, the dates for the beginning <br />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 mao to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, resort, and associated <br />maa. If no new disturbances or reclamation have occurred during the urevious vear and no new chances to <br />the arevious year's man are necessary, then no new mao is required, arovided that the Operator shall state <br />this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffZCe for a written report. <br />Division records indicate the following pennittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Ro/n~Ebberts ~ ~-- <br />(K d71 ~~~;~' <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />Ron Ebberts <br />P.O. Box 250 <br />Egnar, CO 81325 <br />(970)677-2476 <br />(970)677-2776 <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 />-! i ~ 6yt ~.L:~ <br />Signature of Corporate Officer, Owner, or Designed <br />'_~~,_D <br />Date <br />