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� �II IIIIII'I�I�II �I� <br /> 999 <br /> ANNUAL FEE and REPORT REOUEST <br /> PERMITTEE NAME: Ricky W Mitchell MAR 3 0 2001 <br /> PERMIT NO.: M-1987-023 <br /> pjyj6jpp of Minerals end Geology <br /> OPERATION NAME: Mitchell Pit <br /> ANNIVERSARY DATE: March 31,2001 <br /> ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br /> COUNTY: Adams <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 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, ifany. . <br /> Please attach your revised written annual report and annual report maa to this form. Please note that ar. <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verity and make any necessary <br /> changes: <br /> Permittee Contact: Ricky W. Mitchell <br /> Permittee Name: Ricky W Mitchell <br /> Address: P.O. Box 10 <br /> Bennett, CO 80102 <br /> Phone Number: (303)644-4102 <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 /> Signature oftorporate Officer or Owner <br /> 3Las�o l <br /> Date <br /> M\PERMITh1ASTEPDOCUAENrSW-AF-01 <br />