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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNiIAi, FF,F, and RF.PnRT RF.niiF.ST <br />Urralburu Mining Company <br />M-1977-501-UG <br />Marietta Mine <br />February 15, 2003 <br />RECEIVED <br />FEB 12 2003 <br />Division of Minerals and GeOb~r <br />$225.00 (Due on or before your anniversary date) <br />San Miguel <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written anneal rennrt and annual re~nrt m ~n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Benedicto Urralburu <br />Permittee Name: Urralburu Mining Company <br />Address <br />Phone Number: <br />Fax Number: <br />205 N. Willerup Ave. <br />Montrose, CO 81401 <br />(970) 249-5208 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />y~~~~~~ ~~~/~i~ <br />Signature of Corporate Officer, Owner, or Designee <br />~~! /DD a0 D,3 <br />Date <br />M:IPERMITMA$TERDOCUMENT$/M-AF-02.DOC <br />