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ci <br />ANNU~FI~;E and REPORT REQUEST <br />PERMITTEE NAME: ~ Lake County <br />PERMPI' NO.: M-1977-071 <br />./ <br />OPERATION NAME: Half Moon Pit <br />ANNNERSARY DATE: May 25, 2007 <br />ANNUAL FEE DUE: $$688.00 (Due on or before your anniversary date) <br />COUNTY: Lake `~ <br /> <br />~..., ~ ©Gi~~~ <br />Division o. n.,~,amation, <br />~ Mining and Safety <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 cun•ent 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 reuort map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, reuort, and <br />associated man. I_f_no new disturbances or reclamation have occurred durinc the previous vear and no <br />new chances to the previous year's map are necessary, then no new man is required, provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Brad Palmer <br />Pennittee Name: Lake County <br />Address: P.O. Box 964 <br />•o. 'plc ~5Z <br />Leadville, CO 80461 <br />Phone Number: (719) 486-0259 (~ J ~ <br />Fax Number: (719) 486-0259 7 ~ { - ~ SCO ~ ~ ~ /~~` <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 />enclo d. <br />Signature o Corporate Officer, Owner, or Designee <br />y-ate-~~ <br />Date <br />M:~PERMI'MiASTERDOCUMENT5V.I-AF-04 <br />