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<br />t <br />RECEIVED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COi INTY: <br />Rocky West Mining Corp. <br />M-1982-058 <br />Poorman Mine <br />June 14, 2004 <br />$225.00 (Due on or before your anniversary date) <br />Clear Creek <br />MAY 2 5 2004 <br />pivisian ~f 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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date an durmg t e--h -preceding year;'crew-distarbarces-That-sre-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 ynnr revised written annual report and annual rennrt m1p to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may since for a written <br />report. <br />Division records indicate the following petrnittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Alvin Mosch <br />Permittee Name: Rocky West Mining Corp. <br />Address: Box 3236 <br />Idaho Springs, CO 80452 <br />Phone Number: (303) 567-4565 <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 instructions are <br />enclosed. <br />~~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />-~4-a <br />Date <br />M:~PERMITNIASTERDOCUMENTS/M-AF-02.DOC <br />RECEIVED <br />MAY 2 5 2004 <br />Division of Minerals and Geology <br />