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~~ <br />ANNUAL REPORT <br />PERMITTEE NAME: Darryl D Stout <br />PERMIT NO.: M79103 <br />OPERATION NAME: Amick* <br />ANNNERSARY DATE: April 8, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Rio Blanco <br />• iii iiiiiiiiniuiii <br />RECEIVED <br />A(~~l <br />~~ '~ ~ tom' <br />Division of Minerals & ~eob9'1 <br />According to C.R.S. 34-32-116(3)(a), each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a repots and map showing [he extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are <br />anticipated to occur during the upcoming year, reclamation that will be performed during [he coming <br />year, the dates for [he beginning of active operations, and the date active operations ceased for [he <br />year, if any. <br /> <br />Please attach your revised annual report map and written report to this annual report. P/erase <br />More that un adegnarely labeled mnp thnr clearly delineates rant( includes the above elements may <br />since for n written repot!. <br />Please type or print the current contact person's name, mailing address, and phone number in the space <br />provided: <br />Contact Name,//~L 1~ . S}''o cc~ <br />Address~~~D a /0-s'~ <br />~l6 Y,~- <br />Company:,STyw~ ~/Ki'CX f-Rk~C/~ <br />Phone No.: (`}'7U) ~') ,~ .5.3 7 <br />Fax No.: (9 T 0) 8 7R .~ 3 7 f <br />If there are additional comments and/or information that should be provided to the Division, please <br />provide i[ on a separate sheet and attach it to this report form along with your map and/or written <br />report. <br />~~~~~~ <br />Signature of rporate Officer, or Owner Date <br />INSTRUCTIONS ON BACK <br />