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~;~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Alvin Mosch -Patricia Mosch <br />~ M-1982-075 <br />Phoenix Mine <br />June 14, 2007 <br />I <br />~~_,~ <br />- ~ ..,,. <br />! c~, <br />,~ <br />$$225.00 (Due on or before your anniversary date) <br />Clear Creek <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 unn~-- g t if a upcoming year, recfiam~ion that-will-be-performed-zlaring-the-coming year,'the dates far 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 map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, reuort, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chanties to the previous year's map are necessary, then no new map is required, provided that the <br />Ouerator shall state this in the Annaal Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Alvin Mosch <br />Permittee Name: Alvin Mosch -Patricia Mosch <br />Address: Box 3236 <br />Idaho Springs, CO 80452 <br />~s~ sA ~ t p g ~- .v <br />~S L.,ltjT t/C SKI R <br />a ~ EN N a Cy ,4 ,~ el L`'1'r_ <br />M a n s SA nlr r' ` X31 <br /> <br />Phone Number: (303) 567-0422 <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 <br />enclosed. <br />t^d~Lp~ y~~ 6/l~i/! <br />Signature of Corporate Officer, Owner, or Designee <br />-S-a 7 <br />Date <br />M:~PERMIIINASTERDOCUMENTS/M-AF-02.DOC <br />