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999 <br /> ANNUAL FEE and REPORT REQUEST <br /> PERMITTEE NAME: Jelen & Son, Inc. RECEIVE <br /> PERMIT NO.: M-1983-011 APR 0 4 2001 <br /> OPERATION NAME: Willow Creek Mine <br /> ANNIVERSARY DATE: February 23,2001 Division of Minerals and Geology <br /> ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br /> COUNTY: Lake <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, if any. <br /> Please attach your revised written annual report and annual report map to this form. please note that all <br /> adequalely 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 verify and make any necessary <br /> changes: <br /> eya <br /> Perminee Contact: Kay Blecha <br /> Permittee Name: Jelen & Son, Inc. <br /> Address: C/O DWS Investments, Ltd. <br /> 1 153 Bergen Pkwy., M-409 <br /> Evergreen, CO 80439 <br /> Phone Number: (303) 888-2507 <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. n�fi �,� N�4) y.Ca-e hey. <br /> 7-0 9 e 7 <br /> Signature of Corporate Officer or Owner Kn M. P /V d-.1 at <br /> Date <br /> 54i0cf- 0, s �'aSt <br /> M'TERM17VAA5TERDOCUWNT3/M,AF-02 DOC <br />