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//I~ S /T <br />ANNUAL FE and >ftEPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />'Indian Springs Mining <br />/ M-1981-020 <br />Thorsen Mine <br />May 6, 2007 <br /> <br />'~ <br />~jYra'na ~. ~_` <br />1!.i;tir- ~ - -- <"i19n. <br />y ..7~ a-'=~y <br />$$281.00 (Due on or before your anniversary date) <br />Fremont <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 operator <br />t_the annual fee a report and mau 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 map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durine the previous year and no new chances to <br />the previous year's map are necessary, then no new map is required. provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Carlina Henry <br />Permittee Name: Indian Springs Mining <br />Address: 3257 CR 67 <br />Penrose, CO 81240 <br />Phone Number: (719) 372-3907 <br />Fax Number: <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 />Signature of Corporate Officer, Ow r, or Designee <br />~~-Q <br />Date <br />