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<br />ANNiIAi. FF.F. and REPORT RF.OfiF.ST <br />,~i` RECEIVED <br />PERMITTEE NAME: ,t/Sheldon Gosney <br />PERMIT NO.: U M-1977-446 ~~~ l 8 ~ <br />OPERATION NAME: Ignacio Pit ~ ~/rl°l°°°tMtner°ty°°dG~t°~y <br />ANNIVERSARY DATE: December 30, 2005 <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 yeaz, on the anniversary date of the permit, an operator <br />- ---shall submit~he_annnat_fee,-..a-report_and_map_showing_the_extent_of current_disturbances_toJaffected land,_~ _ <br />reclamation accomplished to date and during the preceding year, new disturbances that aze 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 yeaz, if any. <br />Please attach ynnr revised written annnal report and annnal repnrf main to this fnrm_ please note that an <br />adequately labeled map that clearly delineates and includes the 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: <br />Sheldon Gosney <br />Permittee Name: <br />Address: <br />Sheldon Gosney <br />P.O. Box 1186 <br />Bayfield, CO 81122 <br />Phone Number: (970) 884-4684 ~~cE <br />Fax Number: (970) 563-4299 C~,~l <br />970- .SG3- ~a~ <br />9 70 - -~ 5q - ii''1/ <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, Own ro Designee <br />Date <br />