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III IIIIIIIIIIIII III <br />999 <br /> <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />Camp Bird Colorado, Inc. <br />M-1982-090 <br />Camp Bird Mine <br />December 7, 2001 <br />$550.00 (Due on or before your anniversary date) <br />Ouray <br />F~C`•"•.a~1;~D <br />C~~ ~ 3 '"'1 <br />')ivi.:~on of feti~i~..:.,; a+,d Geology <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 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 on <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 pertni[tee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Scott A. Butters <br />Permittee Name: Camp Bird Colorado, Inc <br />Address: P.O. Box 806 <br />236 Sou'rFt EDtSeN S~ R~T- <br />Salt Lake City, UT 841 ]0 <br />Phone Number: {303j-~-25=49~1r- ~gDl) 355 ^ 7 2-Io 0 <br />Fax Number: (801) 521-6400 <br />If you have additional comments and/or information that should be provided to the Division, please provide i[ <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />~..~~ Q ~~o, f~tn~rr r <br />Signature of Corporate Officer or Owner <br />Z8 N 0 V 206 <br />Date <br />M:~PERMnV.1ASTERDOCUMENTS/M~AF~O? DOC <br />