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<br />.a;,; n <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Lance and Bob Barker <br />M-1977-417 <br />Sego Mine <br />November 1, 2003 <br />I1~O!1 U ~ 2DD3 <br />~i~•rar~n of ~Ain~¢!s cog ~^d^•.. <br />$225.00 (Due on or before your anniversary date) <br />Sau Miguel <br />Assording-te-GR~-34-32:5-d I6 or GR-S-34-3?-1-I6,-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 />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 your revised written annnal repprt and annnal r~prt m~ to 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: Lance Barker <br />Permittee Name: Lance and Bob Barker <br />Address: P. O. Box 821 <br />Phone Number: <br />Fax Number: <br />Lake City, CO 81235 <br />(970)944-0155 <br />(970)944-0199 <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 />Signature of Corporate Officer, Owner, or Designee <br />I ~ ~3 /003 <br />Date ~ <br />M:\PERM 17U4ASTERDOC UM ENTS/M-AF-02. DOC <br />_. . f <br />1 <br />J~ i <br />