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} ~ ~ RPM <br />AL 1~EE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE; <br />ANNUAL FEE DUE: <br />COUNTY: <br />vGeorge E. Often <br />(/I~I-1984-013 <br />Mackey Mine <br />May 14, 2007 <br />$$225.00 (Due on or before your anniversary date) <br />Gilpin <br />r~ <br />~, . <br />. _.q <br />~~' - -~~ ~ -, .:y .~, <br />According to C1t:S: 34=32:5=1Z6 or C.R.S: 34=3~=1-16, each year, on-the amtiversary 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 yeaz, if any, <br />Please attach voar revised written anneal tenor[ and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee. report, and <br />associated maa. If no new disturbances or reclamation have occurred darine the arevioas veer and no <br />new chances to the previous vent's man are necessary. then no new man is reanired, provided that the <br />Oaerator shall state this in the Annual Reaort. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may sincejo~ a written report, <br />Division records indicate the following permittee contact informatiJon~Please v~erfif~y and/mak~j any necessary <br />changes: _...~---^E~ ~~~~r' ~ . ~' ~ ~ L//L <br />Permittee Contact: George E. Often a~~-a/~ <br />Permittee Name: George E. Often <br />Address: 11438 CR 19 <br />Fort Lupton, CO 80621 <br />Phone Number: (970) 785-2538 <br />Fax Number: (970) 785-6248 <br />~ .j~- <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. p p <br />Officer, Owner, or <br />-?,~~~ <br />Hate <br />