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• <br />• <br />PERMiTTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br /> <br /> <br />ANNUAL FEE and REPORT REQUEST <br /> <br />Grand Mesa Mining Corp. <br />M-197738 <br />Pickett Corral Mine <br />November 1, 2000 <br />$225.00 (Due on or before December 31.2001 <br />Montrose <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 'eraent of cursent disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are arnicipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates fr~r the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report snd annual report map to this form. Pleare note that an <br />adequatefy labeled map that clearly delineates and includes the above elements may saffice jot a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Raymond Fitzgerald <br />Permittee Name: Grand Mesa Mining Corp. <br />Address: C/O Butler, Fitzgerald and Potter <br />1155 Aveuue of the Americas, 28th Floor <br />New York, NY 10036 <br />• <br />Phone Number: 212-704-3400 <br />Fax Number: 212-302988 <br />If you have additional commerts 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 ®closed. <br />Signature of Corporate OfScer or Owner <br />Date <br />