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~~~~~i <br />ANNUAL ~' E and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />'Joseph L. Dorris <br />~I-2003-030 <br />Glacier Peak Mining <br />June 30, 2007 <br />$$225.00 (Due on or before your anniversary date) <br />Teller <br /> <br />!Ji n <br />,~ ~,.,, <br />A~r'~ <br />7 ~ ~,-,~ <br />~1~ <br />n.. a_. <br />~~on <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 accotnpiistied 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. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chanties to the previous year's map are necessary, then no new man is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Joseph L. Dorris <br />Permittee Name: <br />Address: <br />Joseph L. Doors <br />2920 Cedar Hts. Dr. <br />Colorado Springs, CO 80904 <br />Phone Number: (719) 685-4479 <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 ~h it to this form along with your written report and map. Annual Report instructions are <br />Corporate Officer, Owner, or Designee <br />Date <br />M:~PERMITMAS7ERDOCUMENTS/M-AF-02.DOC <br />