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ANNIiAT. FF,F. and RF.PnRT RFniTFST ~~~~;'lf . ; w <br />PERMITTEE NAME: Gosney & Sons, Inc. OCT 2 '1 2004 <br />PERMIT NO.: M-1987-038 Oiaisien of Niinerats & GeolotlY <br />OPERATION NAME: Bayfield Pit No. 1 <br />ANNNERSARY DATE: November 15, 2004 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <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 />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 />PIPASP. attach ~nnr revised written annnal re~nrf and annnal re,~prt main fn this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Don Gosney <br />Permittee Name: <br />Address: <br />Gosney & Sons,Ine. <br />6699 CR 521 <br />Bayfield, CO 81122 <br />Phone Number: (970) 884-9533 <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 />rf~s~. <br />Signature of Corporate Officer, O er, or Designee <br />i~~~s/©y <br />Date <br />