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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />~ ~ ~~I <br />\NNiiAi. FF,F, and RF,PORT RF <br />' Lance and Bob Barker <br />M-1977-417 <br />Sego Mine <br />November 1, 2005 <br />~~ / <br />RECEIVED <br />0 T 2 7 ~^^~ <br />~9rI ; {'~ Ail G <br />$225.00 (Due on or before your anniversary date) <br />San Miguel <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 accom~ished to date and X11 !n _the-p?'ecediug_year, new_disturbances that azeanticipated_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 />Please attach y9a~r revised written annnal re~nrt and annual rennrt m~ to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Lance Barker <br />Permittee Name: Lance and Bob Barker <br />Address: P.O. Box 821 <br />Lake City, CO 81235 <br />Phone Number: (970) 944-0155 <br />Fax Number: (970) 944-0199 <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 />Sigrl~ture of Corporate Officer, Owner, or Designee <br />~aS~S <br />Date <br />M:~PERMITMASTERDOCUMENTS/M-A£-02.DOC <br />