2005-10-03_REPORT - M1978091UG

• Permit No: M1978091UG
• IBM Index Class Name: Report
• Doc Date: 10/3/2005
• Doc Name: Annual Fee/Report/Map
• From: LKA International Inc.
• To: DMG
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
LI{A International Inc. / '
1978-091-UG
Golden Wonder Mine
October 1, 2005
rc c~
RECEIVED
OCTO~~
Division of Minerals and Geology
$450.00 (Due on or before your anniversary date)
Hinsdale
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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
'-land, reC amatton accomplished fo date and doting tfie pteceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach ym.r revised written annual report and anmtal rennrt man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Lance Barker
Permittee Name: LI{A Intemational Inc.
Address: P.O. Box 82]
Lake City, CO 81235
Phone Number: [phone]
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
Signature of Corporate Officer, Owner, or Designee
Date ~
M:~PERMITVNASTERDOCUMENTSMf-AF-02.IK)C