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• ��� 99I�II�� <br /> ANNUAL FEE and REPORT REOUEST <br /> RECEIVED <br /> PERMITTEE NAME: James VanElla JUL 1 12001 <br /> PERMIT NO.: if19Z,o 50e5 - 45 Division of Minerals and Geology <br /> OPERATION NAME: Gold Basin Mine <br /> ANNIVERSARY DATE: July 21,2001 �S <br /> ANNUAL FEE DUE: y j�= our anniversary date) <br /> COUNTY: Chaffee <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, e:,ch 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 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 the <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 to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br /> report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: ply <br /> Permittee Contact: James VanElla <br /> Permittee Name: James VanElla p <br /> Address: P. O. Box 2221 /B}7ot.+v.ZDO /tea <br /> 51e70 3 <br /> Granite, CO 81228-2221 <br /> Phone Number: (219) 665-7660 <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 /> enclose <br /> AIJ <br /> n <br /> Si ature of Corporate Officer or Owner <br /> U , <br /> �at <br /> A <br /> M:%PERMrrXMASfERDOCUMENFS/M-AF-02 DOC , <br />