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~ ~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Sheldon Gosney FiECElVED <br />PERMfI' NO.: M-1977.446 NOV 2 5 2002 <br />OPERATION NAME: Ignacio Pit Division of Minerals and Geology <br />ANNIVERSARY DATE: December 30, 2002 <br />ANNUAL FEE DUE: $688.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, _ _ <br />reclamation accomplished to dare and duffing the preceding year, new disturbances that are anticipated to occur <br />during [he upcoming year, reclamation that will be performed during the coming year, the dates for [he beginning <br />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 to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permit[ee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Sheldon Gosney <br />Petmittee Name: Sheldon Gosney <br />Address: P.O. Box 1186 <br />Bayfield, CO 81122 <br />Phone Number: (970) 884-4684 <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 aze enclosed. <br />Signature of Corporal.~CSfficer, Owner, or Designee <br />'ri/a~/ate _ --- <br />Date <br />M: W ERM17U1ASTERD000MENTSU-I-AF-01 <br />