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. ~. <br />~~ <br /> `~ ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: `~ Gosney & Sons, Inc. <br />PERMIT NO 1 <br />8 <br />~ <br />.: M- <br />9 <br />7-038 <br />OPERATION NAME: Bayfield Pit No. 1 <br />ANNNERSARY DATE: November 15, 2006 <br />ANNiTAL FEE DUE: $685.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <br />rn'~ <br />Jl~is_~ <br />RECEivE~, <br />~NOV 15`2006 <br />Dlvlelon o- Reclamation, <br />Mining and Safety <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 to affected land, <br />ieclama[ion accomplished to date and during the preceding year, new distu`rtiances that are anticipated to occur <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 report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred durinc the previous vear and no new chances to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Anneal Report. Please note that an adequately Zabeded map that clearly delineates and includes the <br />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: Don Gosney <br />Permittee Name: <br />Address: <br />Gosney & Sons,Inc. <br />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 />Signature of Corporate Officer, Owner, or Designee <br />l ~~j~~o6 <br />Date <br />