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fir: ~~i= <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />A/ tanley J Conner <br />~M-1987-072 <br />Lee No 2 Placer <br />September 26, 206 <br />;~ <br />REC~~V~o <br />o ~t Ep 26?~~~ <br />Min Bands won, <br />r ~°DgMZB'r~Y (Due on or before your anniversary date) <br />Gilpin <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 <br />operator shall submit the annual fee, a report and map showing the extent of cturent 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 yeaz, reclamation that will be performed during the coming yeaz, the dates for the <br />beginning 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 maa to this form. 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 make ece ary <br />changes: -~~/"~ ~~- q ,, ~, <br />Permittee Contact: Stanley J. Conner 1(nf~)17O/~GS ~ 141 V~~ <br />Permittee Name: Stanley J Conner 1 VI ~ l{o ~O ~ 3~ <br />Address: P.O. Box 102073 (~~`~ ~()/n(2~7 <br />~310Q(-Q?5Z <br />Denver, CO 80250-2073 <br />Phone Number: (3031 722-9095 ~ ' ~ ~ l ' ~l~ ' ~.7 ~~ <br />Fax ?dumber <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. Annua] Report instructions are enclosed. <br />Signature of Co orate fficer, Owner, or Designee <br />Date <br />Np CNAN~ES FROM <br />(.~sr YEAR <br />M:IPERMITNiASTERDOC[1MENTS/M-AF-02.DOC <br />