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~~2Y <br />(% AIYNIiAi, FF,F, and RF.P/7RT RF,t7iTFST <br />PERMITTEE NAME / d <br />d M <br />Y <br />h <br />i ~1G~~~~~D <br />: war <br />. <br />c <br />akl <br />PERMIT NO.: ~M-1989-024 1iJUL 12 20~ <br />OPERATION NAME: Shangri La Pit <br />ivision of Minerals and Geology <br />ANNIVERSARY DATE: July 26, 2006 <br />ANNUAL FEE DUE: $281.00 (Due on or before your anniversary date) <br />COUNTY: Custer <br />_Acc4rslivg1o~.g.S._3.4_32S=1lfior_~.R.S._39_32_L15,_each year,_oitthe_anniyersary date oft e.permit,ansperator_ <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <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 ynnr revised written annnal rennrt and anm~al re~nrt maw to this form. The Annual Report <br />& Fee requirement is not met until we have received the following 3 components: ss, repnlj.~nd associated <br />maµ (A113 are required regardless of the level of disturbance or absence of disturbance during the previous <br />year). Please note that an adequately labeled map that clearly delineates and includes the above elements may <br />suffice jor a written report. <br />Division records indicate the following permittee contact information. Please verify and mak necessary <br />changes: <br />Permittee Contact: Edward W. Yaklich /~~ ~ / <br />Permittee Name: Edward M. Yaklich C <br />Address: 1180 CR 129 <br />.1 1 <br />_ . -- - - - - _ ~~ fJ <br />Wes'tcliffe, CO 81252 _ .} <br />Phone Number: (719) 783-4700 <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 ins ctions are enclosed. <br />L~ <br />Si re Corpot to Officer, Owner, or Designee <br />~ /lll~ ~ <br />---,- <br />Data ~ ~ <br />~ ~ <br />,, ~1,t~ ~ <br />~"+ ~~ ,~ <br />1~ ~ ~~,~~! ~~ <br />/~~~i~ <br />b <br />r/~~,r 1 <br />