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r .r <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br />Gosney & Sons, Inc. <br />M-1987-038 <br />Bayfield Pit No. 1 <br />November 15, 2003 <br />i~ECEiVED <br />NOV 1 0 2003 <br />^wision of Minerals and Geolr^• <br />$688.00 (Due on or before your anniversary date) <br />La Plata <br />According to C:Rc5-34 32-5-1-16 or-G.R.S:-34-32-1-16, each year, on-the anniversary date of the-permit; an operator- -- ' <br />'shall submit-ihe annual-fee,-a report-and-map-showing-the-extent-of-current-disturbanees-to-affected-land, - <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur I <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 year, if any. <br />Please attach your revised written annual rennrt and annual rennrf m ~n to this form. Please note thal an <br />adequately labeled map that clearly delineates and includes the above elements may suffrce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Gosney <br />Permittee Name: Gosney & Sons, Inc. <br />Address: 6699 CR 521 <br />Bayfield, CO 81122 <br />Phone Number: (970} 884-9533 <br />Fax Number: <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 />~~~ <br />Signature of Coe Officer, ner, or Designee <br />~b.Jetnn~ae~ 5, ~3 <br />Date <br />M:~PERMITUAASTERDOCUMENTSU.LAF-01 <br />