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t <br />. D7 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />~ Glenn Southwick <br />~M-1986-007 <br />Masonville Stone <br />March 11, 2007 <br />$$281.00 (Due on or before your anniversary date) <br />Larimer <br />tat^CEIVED <br />v r r.H 0 y 2007 <br />~i ion or rteciamanon, <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 />- -sh -fez,-a-repoct-anzl snap showing the extent of currenf-distu-Ur ances to a ecte and, <br />reclamation accomplished to date and during the preceding year, new disturbances 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 durine the previous year and no new changes 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 Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Glenn Southwick <br />Permittee Name: Glenn Southwick <br />Address: 13800 Silver Springs Rd <br />Jay Em, WY 82219 <br />Phone Number: <br />Fax Number: <br />(307) 334-2880 <br />~o - s~g~ o~v a. <br />If you have additional comments and/or information that should be <br />below or attach it to this~fjonn along with your written report and map. <br />-~~~ Y ~\ <br />Signature of Corporate Officer, Owner, or Designee <br />a - ~--o ~ <br />provided to the Division, please provide it <br />Annual Report instructions are enclosed. <br />Date <br />