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<br />PERMITTEE NAME: Urralburu Mining Company FLu ~ 0 2Ci;5 <br />PERMIT NO.: M-1977-501-UG ,,,;,. • <br />OPERATION NAME: Marietta Mine <br />ANNIVERSARY DATE: February 15, 2005 <br />ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br />COUNTY: 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 accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occ~ng~pcommg year, re~tton 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 your revised written annual report and annual red art m ~n to this form. Please note that an <br />adequately tabeled 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: Benedicto Urralburu <br />Permittee Name: Urralburu Mining Company <br />Address: 205 N. Willerup Ave. <br />Montrose, CO 81401 <br />Phone Number: (970) 249-5208 <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 />~~ ~~~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />Nothing has changed--it is the same <br />as last year's report. <br />~~.~~ fi .~7d 0 s <br />Date <br />M: W ERMITMASTERDOCUMENTS/M-AF-02.DOC <br />