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R <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />iii ~~iiiiiiniu iii <br />ANNUAL FEE and REPORT REQUEST <br />Lance and Bob Barker <br />M-1977-417 <br />Sego Mine <br />November 1, 2001 <br />$225.00 (Due on or before your anniversary date) <br />San Miguel <br />RECEIVED <br />N(IV 0 5 1001 <br />Division t t Minerals and Geology <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 shalFsubmit 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 [he <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 [o this form. Please mote rl+nt art <br />adequately Inbeled map rhnt clearly delineates and includes the nbove elenrenrs pray sujfee for n written <br />report. <br />Division records indicate [he following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee ContacC Lance Barker <br />Permittee Name: Lance and Bob Barker <br />Address: P. O. Box 821 <br />Lake City, CO 81235 <br />Phone Number: <br />Fax Number: <br />944-0199 <br />944-0155 <br />or53 <br />~r49 <br />If you have additional co~i veSents 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 />-7lIP /11~-~P 51f P 1'Pw~atr-5 /vloc~>1I~P <br />..,~11 L_~Q~_lr/) ~ - 5-fP urckengl~d sync P ~tas-~- <br />Signature of Corporate Officer or Owner <br />InS~P~ftu~ ~.~ '~Ml, <br />Date T~_ <br />lv13d ~~~xJ~ ` OVa ~~r~ -f~ltr,p ~'ru-r~' - 6~`(- <br />re ^.~Gwlaflu/! w1LL ~,;rt~rn~IP, <br />SAP ,n~,~ ~~ ~IIP - NG e~a~9~ <br />M;tPERMrtW1ASTERD000MENTS/M-AF-O? DOC <br />