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<br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.; <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Pitkin Iron Corporation <br />M-1982-121 <br />Mid-Continent LST <br />Apri125, 2002 <br />MAR 1 52001 <br />Division of Minerals and Geology <br />$688.00 (Due on or before your anniversary date) <br />Ga~eld <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 [o affected land, <br />reclamation accomplisfied [o`daie°and`duiing the preceding year, new`disturb~ttces'ihat'ara'artticipated'to`occar <br />during the upcoming year, reclamation [hat 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 your revised written annual report and annual report map 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 and make any necessary <br />changes: <br />Permittee Contact: Robert J. Delaney <br />Permittee Name: Pitkin Iron Corporation <br />Address: 0755 Airport Rd. <br />P.O. Box 1298 <br />Glenwood Springs, CO 81601 <br />Phone Number: (970) 945-0703 <br />__- Fax,Number: _ __ _(303) 945-0703_ .. ___ _ . _ - . __- _ <br />If you have additional comments and/or information that should be provided to the Division, please provide i[ <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />,f.,f~~-~s,D!nf <br />Signature f Corporate fficer or Owner <br />3-/2 -z~oz <br />Date <br />M?PERM ITU~IASTERDOCUM EMSNI-AF-01 <br />