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5~ <br />1/ ANNIIAI. FF,F. and RF.PnRT RF.(~:S'1' <br />PERMITTEE NAME: ~ Melvin R Gydesen <br />PERMIT NO.: / M-1982-020 <br />OPERATION NAME: Lucky Strike Lode <br />ANNIVERSARY DATE: May 25, 2006 <br />~~ <br />~iECE~VE® <br />'/MAY 2 2 Zoos <br />~ivisian al Minerals and GealoSY <br />ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br />COUNTY: Gunnison <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 <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 />ti <br />Please attach ymtr revised written annual rennrt and annual re~nrt main M this form- Please note that nn <br />adequately labeled map that clearly delineates and includes the ahove elements may since for a written <br />report...,A ~~ ~ ~ ~ ~ ~ ~ ~ <br />Division records indicate the llowing permittee contact information. Please verify end make any necessary <br />changes: <br />Permittee Contact: Melvin R. Gydesen <br />Permittee Name: Melvin R Gydesen <br />Address: 5062 N Raymond Rd <br />Luther, MI 49656-9749 <br />~3~-~ -sago <br />Phone Number: <br />Fax Number: <br />Q~ / `~ <br />>~ >~• <br />~_ O-t ~ O (gyp <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 />enclosed. <br />Signature of Corporate Of tcer, Owner, or Designee <br />f ~ O <br />Date <br />M:\PCRM IT\MASTER DOCUM ENTS/M-AF-(12. DOC <br />